Milton H. Erickson

Milton Hyland Erickson (5 December 1901 – 25 March 1980) was an American psychiatrist and psychologist specializing in medical hypnosis and family therapy. He was the founding president of the American Society for Clinical Hypnosis. He is noted for his approach to the unconscious mind as creative and solution-generating. He is also noted for influencing brief therapy, strategic family therapy, family systems therapy, solution focused brief therapy, and neuro-linguistic programming.

Early life and education

Biographical sketches have been presented in a number of resources, the earliest being by Jay Haley in Advanced Techniques of Hypnosis and Therapy which was written in 1968 and in collaboration with Erickson himself. Though they never met Erickson, the authors of The Worlds Greatest Hypnotists wrote a biography. The following information about his life is documented in that source.

Milton Hyland Erickson was the second child of nine of Albert and Clara Erickson. He was born in a mining camp in Aurum, Nevada where his father mined silver. The family moved to the farming community of Beaver Dam, Wisconsin when he was quite young and settled on a modest farm. The children (two boys and seven girls) all attended the one-room schoolhouse in nearby Lowell. The family farm demanded a great deal of physical labor.

Erickson was late in learning to speak and had difficulties in reading, which he described as dyslexia. He was also color blind and tone deaf. Later in life, when he explained what seemed to be extraordinary abilities, he stated that the disabilities (dyslexia, color blindness, being tone-deaf) helped him to focus on aspects of communication and behavior which most people overlooked. This is a typical example of emphasizing the positive, which is characteristic of his overall approach.

Though the family valued education, books were scarce. Erickson's desire to learn led him to repeatedly read the dictionary from front to back, along with the few other texts that the family treasured. He claimed to have overcome his dyslexia and described the pivotal moments in a paper entitled "Auto-hypnotic Experiences of Milton Erickson," which is found in The Collected Works of Milton H. Erickson, MD. He later characterized his early moments of creative change (which he described as a "blinding flash of light") as an early spontaneous auto-hypnotic experience.

Erickson became interested in hypnosis at an early age when a traveling entertainer passed through the area. According to his later description, he felt that hypnosis was too powerful a tool to be left to entertainers. He decided to bring this tool into the realm of scientific evaluation as well as into the practice of medicine. Erickson already admired the local community doctor and had committed himself to becoming a physician.

After recovering his ability to walk Erickson attended the University of Wisconsin-Madison, where he attained graduate degrees in both psychology and medicine. There he also embarked on formal studies of hypnosis in the laboratory of Clark Hull. However, because his ideas were somewhat different from Hull's, Erickson independently embarked upon rigorous scientific explorations regarding the nature of hypnosis. He received his M. D. degree from the University of Wisconsin School of Medicine with an emphasis on Neurology and Psychiatry in 1928. Between 1929 and 1948, Erickson then took a series of positions at state hospitals that facilitated active research. He continued research in hypnosis as he refined his practical therapeutic skills. He was already a prolific writer focusing primarily on case studies and experimental work. These earlier writings greatly advanced the general understanding of hypnosis and are included in The Collected Works of Milton Erickson, M.D.

In his late 40s Erickson developed post-polio syndrome. This resulted in additional muscle loss and pain.

His ongoing relationship with Gregory Bateson led some to take an interest in Erickson's unique communication skills and therapeutic approaches. In 1973 Jay Haley published Uncommon Therapy, a book that first brought Erickson and his approaches to the attention of those outside the clinical hypnosis community. Erickson's fame and reputation spread rapidly, and so many people wished to meet him that he began holding teaching seminars. These continued until his death.

Throughout his professional career Erickson collaborated with a number of serious students. Colleagues who recognized the uniqueness and effectiveness of Erickson's approaches collected his publications into many volumes. His weekly workshops remained popular until his death. Towards the end of his life, Erickson's students began to formulate conceptual frameworks for his work and to explain and characterize it in their own way. Those efforts have influenced a vast number of psychotherapeutic directions, including brief therapy, family systems therapy, neuro-linguistic programming, among others. Andre Weitzenhoffer points out: "The Ericksonian 'unconscious' lacks in particular the hostile and aggressive aspects so characteristic of Freud's system".

Erickson relied on a supposition of an active, significant, unconscious. It was Erickson's perspective that hypnosis provided a tool with which to communicate with the unconscious mind and access the reservoir of resources held within. He describes in a 1944 article on unconscious mental activity, "Since hypnosis can be induced and trance manifestations elicited by suggestion, the unwarranted assumption is made that whatever develops from hypnosis must be completely a result of suggestion, and primarily an expression of it. The hypnotized person remains an individual, and only certain limited general relationships and behavior are temporarily altered by hypnosis. Hypnosis is in fact the induction of a peculiar psychological state which permits subjects to reassociate and reorganize inner psychological complexities in a way suitable to the unique items of their own psychological experiences." In the same publication Erickson repeatedly comments about the autonomy of the unconscious mind and its capacity to solve problems.

The essential element of Erickson's jokes was not hostility, but surprise. It was not uncommon for him to slip indirect suggestions into a myriad of situations. He also included humor in his books, papers, lectures and seminars.

Early in his career Erickson was a pioneer in researching the unique and remarkable phenomena that are associated with that state, spending many hours at a time with individual subjects, deepening the trance. Erickson's work on depth of trance is detailed in his 1952 paper in which he provided history, justification, and ideas about its use. ("Trance states for therapeutic purposes may be either light or deep, depending on such factors as the patient's personality, the nature of his problem, and the stage of his therapeutic progress". )

Where traditional hypnosis is authoritative and direct and often encounters resistance in the subject, Erickson's approach is permissive, accommodating and indirect.

Techniques While Erickson explored a vast arena of induction methodologies and techniques of suggestions, there are certain areas where his name is known as key in the development or popularity of the approaches. He used direct and indirect approaches, though he is most known for his indirect and permissive suggestion techniques.

Indirect suggestions Erickson maintained that it was not consciously possible to instruct the unconscious mind, and that authoritarian suggestions were likely to be met with resistance. The unconscious mind responds to opportunity, metaphors, symbols, and contradictions. Therefore, effective hypnotic suggestion should be "artfully vague," leaving space for the subject to fill in the gaps with their own unconscious understandings – even if they do not consciously grasp what is happening. He developed both verbal and non-verbal techniques and pioneered the idea that the common experiences of wonderment, engrossment and confusion are, in fact, just kinds of trance. An excellent example of this can be viewed in the documentary film.

Metaphor Erickson sometimes instructed people to climb a mountain or visit a botanical garden. His narrative and experiential metaphors are explored extensively in Sydney Rosen's My Voice Will Go With You, but an example is given in the first chapter of David Gordon's book Phoenix. The following quotes Erickson: I was returning from high school one day and a runaway horse with a bridle on sped past a group of us into a farmer's yard looking for a drink of water. The horse was perspiring heavily. And the farmer didn't recognize it so we cornered it. I hopped on the horse's back. Since it had a bridle on, I took hold of the tick rein and said, "Giddy-up." Headed for the highway, I knew the horse would turn in the right direction. I didn't know what the right direction was. And the horse trotted and galloped along. Now and then he would forget he was on the highway and start into a field. So I would pull on him a bit and call his attention to the fact the highway was where he was supposed to be. And finally, about four miles from where I had boarded him, he turned into a farmyard and the farmer said, "So that's how that critter came back. Where did you find him?" I said, "About four miles from here." "How did you know you should come here?" I said, "I didn't know. The horse knew. All I did was keep his attention on the road."

Interspersal technique Erickson describes hypnotic technique as a means to an end while psychotherapy addresses guidance of the subject's behaviors. As such, the same hypnotic technique can be applied towards diverse patient concerns. In his discussion of the applications of the interspersal technique, Erickson offers two case examples in which a similar application of the technique was made. One patient was suffering from intolerable malignant pain from a terminal condition, while the other subject was an intelligent though illiterate man who sought to relieve a disabling symptom of frequent urination. Erickson provides an interesting case write up for each of the cases chosen to illustrate his use of the interspersal technique. Erickson provides a transcript for the induction in which he interwove personalized therapeutic suggestion, selected specifically for the patient, within the hypnotic induction itself. The transcript offered illustrates how easily hypnotherapeutic suggestions can be included in the trance induction along with trance-maintenance suggestions. In the follow-up case discussions Erickson credits the patients' positive responses to the receptivity of their unconscious minds: they knew why they were seeking therapy, they were desirous of benefiting from suggestions. Erickson goes on to state that one should also give recognition to the readiness with which one's unconscious mind picks up clues and information. Erickson stated that "Respectful awareness of the capacity of the patient's unconscious mind to perceive the meaningfulness of the therapist's own unconscious behavior is a governing principle in psychotherapy. The patient's unconscious mind is listening and understanding much better than is possible for his conscious mind".

Confusion technique "In all my techniques, almost all, there is a confusion". – Milton H. Erickson

Erickson describes the confusion technique of hypnotic induction that he developed as being done either through pantomime or through plays on words. Spoken to attentive listeners with complete earnestness, a burden of constructing a meaning is placed upon the subject, and before they can reject it another statement can be made to hold their attention. One example is offered in which he uses verb tenses to keep the subject "…in a state of constant endeavor to sort out the intended meaning". He offers the following example: One may declare so easily that the present and the past can be so readily summarized by the simple statement "That which is now will soon be yesterday's future even as it will be tomorrow's was. Thus the past, the present, and the future all used in reference to the reality of today". Erickson describes the second element of confusion to be the inclusion of irrelevancies and non-sequiturs. Taken in context these verbal distractions are confusing and lead progressively to the subject's earnest desire for and an actual need to receive some communication they can readily understand. A primary consideration of the confusion technique is the consistent maintenance of a general causal but definitely interested attitude and speaking in a gravely earnest and intent manner expressive of a certain utterly complete expectation of the subject's understanding. Erickson wrote several articles detailing the technique and results that can be achieved. This succinct overview comes from a 1964 article, one of several detailing the technique, the justification and the responses that could be achieved.

Handshake induction Erickson describes the routine as follows:

Resistance In the book Uncommon Therapy, Jay Haley

Shocks and ordeals Erickson is famous for pioneering indirect techniques, but his shock therapy tends to get less attention. Erickson was prepared to use psychological shocks and ordeals in order to achieve given results: The ordeal process is different from other therapeutic techniques originated by Erickson. Extending the dissociative effects of paradox and non sequitur, wherein confusion is used only as an entry to a trance state, the technique of ordeal superimposes a distressing but achievable challenge over the therapeutic aim such that the achievement of the former implies a positive outcome in the latter. Hence ordeal therapy is not merely an induction technique but a theory of change. The therapist's task is to impose an ordeal, appropriate to the problem the person wishes to change, an ordeal more severe than the problem. The main requirement is that it will cause distress equal to or greater than that caused by the symptom. It is also best that the ordeal is good for the person. The ordeal must have another characteristic: it must be something the person can do. It must be of such a nature that the therapist can easily say "This won't violate any of your moral standards and is something you can do". The final characteristic is that it should not harm anyone else. One final aspect of the ordeal is that sometimes the person must go through it repeatedly to recover from the symptom.

Influence on others One of Erickson's first students and developers of his work was Jay Haley. Other important followers who studied directly with Erickson include Ernest Rossi, Stephen Gilligan, Jeffrey Zeig, Bill O'Hanlon, Michele Ritterman, Stephen Lankton, Richard Landis, Jane Parsons-Fein, Herb Lustig, Alex & Annellen Simpkins and Sidney Rosen.

Erickson eschewed rigid approaches to therapy and thus never accepted a binding framework or schematic set of procedures during his lifetime, though a multitude of other approaches grew from his perspective and practice. He had a strong influence on the diverse areas of Strategic therapy, Family Systems, Brief Therapy, Ordeal Therapy, Narrative Therapy, and Neuro-Linguistic Programming.

Ericksonian approaches Following Erickson's death in 1980, The Erickson Foundation held a conference which at the time was the largest professional hypnosis conference ever held. More recently, the development of Ericksonian Core Competencies spearheaded by Dan Short and Scott Miller defines Ericksonian approaches in a manner that makes it amenable to evidence-based studies.

Lankton and Matthews state that perhaps Erickson's greatest contribution to psychotherapy was not his innovative techniques, but his ability to de-pathologize people and consider a patient's problematic behavior as indicative of a best choice available to the individual. His approach was to facilitate the patient's access to inner resources to solve the problems.

A 1954 article by Erickson describes his technique of utilizing a patient's own personality and ideas, "Doing it His Own Way", in which a patient requested hypnosis for the explicit purpose of ceasing his reckless driving, and the patient did not want psychotherapy for any other purpose. Erickson worked with him and provided a summary of the case, after carefully assessing the patient's potential for safe practices, as well as his motivation for change. The discussion of working with the patient while allowing him to guide his own healing is a clear example of the concept of utilization for which Erickson has become known. Another key principle that is associated with Erickson's techniques is described in his 1964 paper entitled the "Burden of Effective Psychotherapy" whereby he describes the essential nature of the investment of the subject in the experiential process of healing.

An entry in the American Psychological Association Dictionary of Psychology defines Ericksonian psychotherapy as a "form of psychotherapy in which the therapist works with the client to create, through hypnosis and specifically through indirect suggestion and suggestive metaphors and real life experiences, intended to activate previously dormant intra-psychic resources".

Controversy A colleague, friend and fellow researcher, André Weitzenhoffer, an author in the field of hypnosis himself, has criticized some ideas and influence of Erickson in various writings, such as his textbook The Practice of Hypnotism. Weitzenhoffer displays a clear and explicitly stated, opposition to Ericksonian hypnosis in his book, in favor of what he terms the semi-traditional, scientific, approach. Rosen alludes to the uncertainty that can result from his clinical demonstrations: "This has nevertheless raised the question of whether or not the patient is playing a role by pretending not to feel pain…" Erickson's daughter Roxanna Erickson-Klein, also a trained psychotherapist, validated this uncertainty about the completeness of Erickson's case reports and demonstrations. She added that although he tirelessly advocated scientific investigations of hypnosis and was a prolific writer on techniques, he often left details out of case reports that could have been meaningful to clinicians of today. More importantly, critics often overlook the context of the times. He was a physician who worked from a framework of a country doctor, and clinicians of today are hasty to judge by today's standards, while not taking into consideration the context of the times.

Self-professed "skeptical hypnotist," Alex Tsander, cited concerns in his 2005 book Beyond Erickson: A Fresh Look at "The Emperor of Hypnosis", the title of which alludes to Charcot's characterization in the previous century as "The Napoleon of the Neuroses." Tsander re-evaluates a swathe of Erickson's accounts of his therapeutic approaches and lecture demonstrations in the context of scientific literature on hypnotism and his own experience in giving live demonstrations of hypnotic technique. Emphasizing social-psychological perspectives, Tsander introduces an "interpretive filter" with which he re-evaluates Erickson's own accounts of his demonstrations and introduces prosaic explanations for occurrences that both Erickson and other authors tend to portray as remarkable.

In an audiotape that is attributed to him, Dharma Teacher Tenshin, Reb Anderson of the Zen tradition, has referred to Erickson as a "Magician/Healer." Zeig concurs that professional skepticism and education is paramount for the advancement of a discipline. He states "Among psychotherapists there are some who worship Erickson with a reverence that borders on idolatry. Every word, sentiment, opinion, or act is presumed to have an inspired meaning. Such deification rooted in expectation of timeless power and omnipotence can ultimately lead to disillusionment. Equally prejudiced are those who regard Erickson as a maverick whose egregious methods are a passing fancy that will eventually be consigned to the dustbin of outmoded schemes. [Both] these attitudes do injustice to a highly creative and imaginative original mind... A poignant criticism of Erickson's strategic therapy is that it is overvalued by those who believe that clever tactics can substitute for disciplined training."