What hypnosis is not

When hypnosis is spoken of, people generally think of a loss of consciousness, of one person controlling another and giving orders that the other irremediably obeys. They also think of something that would work magically and could make symptoms and behaviours that do not yield to the will disappear.

While it is true that, in a state of deep trance, consciousness is lost (the person falls asleep), it is not true that the hypnotist has absolute control over the hypnotised person. Freud stopped using hypnosis as a therapeutic method because his patients sometimes refused to remember what he ordered them to recall.

We may define hypnosis as a method for inducing a state, trance, in which the critical mental faculties are temporarily and partially suspended and in which the person mainly uses their imagination and the primary process. It is a matter of inducing a guided reverie, of making it easier for the other to be in contact with their own inner world.

Trance is a natural state that we enter spontaneously. A light trance is a guided reverie; sleep is a deep trance.

From direct suggestion to the handling of fantasy

In the past, in classical hypnosis, the emphasis was placed on direct suggestion. Today, in the “new hypnosis”, as Daniel Aráoz calls it, or in Ericksonian hypnosis, the emphasis is placed on the handling of fantasy.

This new hypnosis has its antecedents in the 1930s in France, with the developments of the Nancy School, which broke away from the lines of work of the Salpêtrière and proposed that:

Milton Erickson, an American psychiatrist, implemented and developed hypnotic techniques out of these same ideas in an almost miraculous way. To this day, his disciples continue to decipher and put into words what he did.

As I pointed out above, the basis of hypnotic techniques is imagination and suggestion. For suggestion, the patient’s own words are used, together with ambiguous terms, so that they take on their own meaning in each person, according to that person’s individual problems, desires and needs; or else metaphors are used to which each person can give their own content.

Working with this type of hypnosis consists in fostering a guided reverie that makes it possible to explore repressed material without analysing the defences, to come into contact with unconscious phantasies (bonds and internal objects) in order to modify them and set processes going. A new inner “reality” is thus built, which produces “real” changes in the person.

Three theoretical supports: the unconscious, the hemispheres, constructivism

Hypnotic techniques have spread more and more widely, above all in the United States, unfortunately at times as techniques isolated from any solid body of theory. I consider, however, that their theoretical foundation can be found in the concept of the Unconscious developed by psychoanalytic theory, in the studies carried out on the differences in the functioning of the cerebral hemispheres, and in constructivism, an epistemology developed by, among others, Doctors Von Foerster, Von Glasersfeld, Watzlawick and Varela.

Psychoanalysis speaks to us of the Unconscious as that entity made up of psychic energy, which contains the memory traces of everything that has been lived (memories that are images and affects); which is made of internal objects and unconscious phantasies, products of the interaction with the outside, and in which processes of restructuring are continually taking place, many of them oriented towards the “protection” of the person against the reliving of painful experiences. In this type of hypnosis, as in psychoanalytic theory, the symptom is considered to have “a valuable purpose”, to be the compromise between drive and defence: it is therefore respected. In other words, for this new hypnosis the Unconscious is not merely the dustbin where what is ugly, bad and painful lies repressed; it is fundamentally energy, resources, capacities, protection, and it contains beautiful memories that are useful.

During the hypnotic process, we call upon the strength of the unconscious mind, we use the traces of pleasant memories — taking it for granted that there are always some; internal objects and unconscious phantasies are modified; processes are set going and reoriented.

All this by following the path of the unconscious, which is the pleasure principle. Thus, therapeutic treatment with this type of hypnosis is not fundamentally an arid and painful path: it tends to be fluid and pleasant.

And, according to the research carried out on the difference in the functioning of the cerebral hemispheres, the path of the Unconscious is that of the right hemisphere.

Paul Watzlawick stresses how far the functions of this hemisphere — symbolisation, condensation, analogical language, vision of totality, of synthesis, representation of the whole through its parts, registering and perception of sensations and affects — coincide with those that psychoanalysis attributes to the Unconscious, whereas the left hemisphere is in charge of logical reasoning, of verbal language and mathematical language, as well as of the function of analysis, which would correspond to conscious thought.

Our culture tends to overvalue the functions of the left hemisphere, the hemisphere of logic and reason, and to devalue those of the right, the hemisphere of sensitivity, imagination and sensation. In hypnosis, we do the opposite. We work with the right one, seeking to develop its potentials and partially to block the left one.

Finally, constructivist epistemology proposes that, whatever REALITY may be, we can never know it as it is. Through our senses and our interaction with it, we construct our world, almost always without realising it. Radical constructivism goes so far as to assert that REALITY does not exist, but that we construct it. We construct our inner reality. And it is this inner reality that determines our behaviours, our affects, our attitude towards the world. Consequently, if we change our inner reality, our behaviours and our affects will change: this is precisely what we do through hypnosis.

Hypnosis is a very powerful tool, since it works with the resources of the right hemisphere, generally underused in our culture. It is an interesting technical alternative when others have proved ineffective, and it is particularly valuable when the recursive patterns through which the tendency towards non-change operates are fundamentally verbal and logical, that is to say when they correspond to the functioning of the left hemisphere.

Hypnotic techniques, like any type of technique, must be situated within a therapeutic context — here, that of systemic family therapy — which frames them and gives them meaning.

In what follows I illustrate, through a case study, a style of working with hypnotic techniques. I first present its background, then a brief description of the techniques used, before describing the therapeutic process and, finally, commenting on it.

Background

Pablo and Elena are one of those young Mexican middle-class couples in which both the man and the woman want to build a relationship different from that of their parents. They reject traditional roles. He wants to take on and share domestic responsibilities, and she economic ones. They reject the rigid complementary relationship in which the submission of their mothers and the domination of their fathers were played out. They advocate equality between men and women and establish a symmetrical relationship. They have not, however, learnt to function in this way, they have no model to follow. The result is often painful failures, because, in their search for equality, they establish symmetrical escalations that lead them to a break — and then to carrying on the escalation as soon as they come back together.

He, an economist, is 29 years old and has a history laden with illness: heart problems, frequent kidney infections, several operations and bone fractures, and now a cancer, which he is beginning to treat with chemotherapy.

She, a psychologist, is 27 years old and has epilepsy controlled by medication. They have been married for a year.

They come to therapy seeking support in the face of the anxiety caused by the appearance of the cancer. They also want to learn to cope better with Pablo’s family, which “invades them” by wanting to help. His father, a doctor, pays for the chemotherapy, is present at every consultation, argues and quarrels with the members of the team treating Pablo, and interferes with the treatment. He moves into their home in order to care for him and keep watch over him.

From the very first session, the great symmetry that existed between them was plain to see, rationalised and buttressed by the discourse of equality. Until then, however, this symmetry had been deflected towards confrontation with external elements: the families of origin of one and the other, the illnesses and, from now on, Pablo’s father.

As a couple who were just beginning, their most apparent conflicts were: a) building boundaries around their couple, which was all the more difficult at a time when they needed financial help for Pablo’s treatment; and b) establishing patterns of interaction between them, integrating two different styles and two different visions of the world.

Elena described herself as untidy and rebellious towards authority; she said she experienced Pablo’s demand for more order as an aggression. She saw Pablo as excessively dependent, authoritarian and violent.

Pablo considered himself tidy and experienced Elena’s untidiness as an aggression, as a lack of respect towards him. He saw Elena as untidy and rebellious, with abrupt and frequent changes of mood.

At first, the therapy was oriented towards supporting them while Pablo was receiving his treatment, and towards helping them set limits with Pablo’s father. When the chemotherapy came to an end and they began to live a situation of normality, the frequency of the escalations increased, over any pretext whatsoever: she called him a macho and a dependent man when he asked her to serve him a cup of coffee; he called her untidy on any pretext; and they spent more and more days without speaking to each other. The escalations only diminished on the eve of Pablo’s periodic check-ups, or when Elena “forgot” to take her medication and had an epileptic seizure. At those moments, they said they loved each other, that they wanted to enjoy life together and to build a different kind of couple.

I used various structural and paradoxical techniques without success, after which I proposed that we work “on another level”, without words, so as to avoid their continuing to attack each other verbally. That is how we began the therapeutic process I present below.

The techniques used

We worked essentially with two types of technique: the representation of their relationship in metaphors, and rehearsal.

The metaphor is a symbolic representation of a situation; as such, it is synthetic, totalising, it condenses different elements, and it is situated in the right hemisphere of the brain, which, being the hemisphere of the unconscious, is also the one in which the symptoms are situated.

A metaphorical communication is a direct communication with the right hemisphere, in its own language: hence its strength.

The metaphor has two levels and two meanings: one superficial, apparent, formed by the verbalisation of the metaphor, which activates the second, deeper one, almost always unconscious, which is relevant and meaningful for each person who hears it or lives it. When a person generates a metaphor, it expresses the dynamics of that level, their inner reality; and the changes that will take place in the metaphor will take place simultaneously at that deep unconscious level, in that inner reality, and will consequently determine changes in that person’s affects and behaviours.

Even though there are metaphors that the therapist can propose, as is the case with the teaching tales told by Milton Erickson, I prefer metaphors created by the patient themselves, and prefer to suggest from the outside the setting in motion of processes that are generated from within each person.

The idea of working with the symbolic representation of a bond came to me on discovering the work that Peggy Papp carries out with groups of couples, which she calls “couples choreography” and describes as follows:

These fantasies are then dramatised before the group.

My way of working consists in inviting each member of the couple to represent the problem of their relationship in a metaphor, set in a scene. We then work with the metaphors created by both of them. In each one, I propose that they remain observers and I suggest that THE SOLUTION TO THE CONFLICT IS BEING GENERATED.

Session after session, we return to the metaphors, thereby suggesting that they follow a process. I open the session and the induction of trance with an indirect suggestion (for example: “do you know how tigers heal themselves?”), which implies that they will live that healing in the trance, and I let the fantasy run. Before ending the trance, I formulate post-hypnotic suggestions that are process instructions, of the kind of the Blessing devised by Bandler and Grinder, in which it is suggested that the process that has been set going will continue that night and every night that is needed, while the patients sleep, using the mechanisms by which dreams are formed, in such a way that they will be surprised to find themselves acting and feeling in a new and different way.

I then ask them to recount their fantasy. This is important in order to know how the process is unfolding and so that they may share what they have lived. I do not interpret and I make no remarks, unless these are formulated in the language and the context of the metaphor, so as to go on working with the right hemisphere and to avoid the intrusion of the left one. In this case, it was never said that Pablo and Elena were the tigers or the flowers, although they knew it. They had important insights, even without expressing them verbally.

The focus of the sessions is the material of the metaphor. If other themes are broached, it is only “in the meantime”, while the changes that must take place at the metaphorical level occur: while the tigers sleep, for example, and the plants heal.

The use of metaphors can be complemented by another type of hypnotic technique, such as the rehearsal I now present.

Rehearsal

This is a very simple technique by which the person is brought to give themselves, analogically, the autosuggestion they are willing to give themselves. It consists in asking each member of the couple to construct a scene in which they are “feeling the way they want to feel, living the way they want to live, acting the way they want to act”, and to live it in all its details. In creating this fantasy, they are already creating a new inner reality. Moreover, the description of the fantasy can be used as a diagnosis.

The process

Eight sessions were held, one week apart.

In the first session, I proposed that each of them construct a metaphor. Elena visualised a plant, like an iris, with one stem and two flowers, each turned towards a different side… The root and the stem did not allow them to be different.

When I asked them to visualise a solution to this situation, both Pablo and Elena saw themselves dividing the stem and the root in two, and planting the two plants separately, but close to one another. I proposed that they give the plants time to adapt to their new soil, and we moved on to work on Pablo’s metaphor.

Pablo saw, at the same time as he felt a deep sadness, two wounded tigers who respected and feared each other. He said: “they are in a very bad way, with open, bleeding wounds… they need to take it out on someone… they could join together, because the jungle is very harsh and it is difficult to find a partner there… they were sickly cubs, weak and mistreated…”

Elena entered the scene and observed how the cubs fought and clawed at each other, not knowing how to be together; she discovered that the scratches made them momentarily forget their wounds. Seeing them grow up so damaged, Elena wept.

I asked them to go up to them and to look at their wounds so as to realise how these might heal. Elena went up and one of the tigers let her put alcohol on him. Pablo did not manage to go near the tigers; from a distance, he observed that the wounds were deep. On coming out of the trance, both of them acknowledged their wounds and wept over them.

In the second session, I first asked them to go back to the scene of the flowers to see how they were doing. Both found them weakened, but the wound on the stem was beginning to heal. I then asked them: do you know how tigers heal themselves when they are wounded? And, from there, we took up the work again in a state of trance.

Pablo saw the tiger stretched out, doing nothing, at the edge of a river. A little later, the tiger went into the water, which Pablo felt to be delicious; then he came out onto the bank, lay in the sun, rested for a while and dried off; he walked to the thicket and there fell into a deep sleep, a little sad and very thirsty.

Elena recounted that at first the tiger frightened her and that she hid in the undergrowth. “He walked along, majestic, even if no one could see him, and he was not limping; I knew he was wounded. I saw him hesitate to go into the cold water, the deep wound under his foreleg was hurting him. At first it hurt him horribly in the water, then he liked it. When he had finished bathing, he went and lay down in some grass, he ate and he slept.” Once the tiger was asleep, Elena dared to go up and watch him sleeping, happy — so defenceless! — so different from what he seemed to be… and the wound was closing…

I suggested that these stories continue through their dreams and that, the next time, we might see how far the wounds of the tigers and of the plants had healed.

During the week that passed between this session and the next, Elena agreed to have a tomography scan that the neurologist had been asking her to have for several months.

They arrived at the third session saying that they were calmer, a little more distant from each other, and that this was perhaps why the quarrels had diminished. We went to see how the flowers were getting on and, since they had recovered a little, we moved on to the tigers, who were still asleep. I suggested that we let them sleep for as long as was needed for the healing to follow its natural process. On their own initiative, we devoted the rest of the session to reaching agreements about the sharing of domestic tasks. It was the first time they had been able to do so.

The following time, the fourth session, they arrived preoccupied by what they called their demandingness and their perfectionism. Finding a fault in themselves or in the other affected them a great deal; they could not accept bad moments. They felt sad but calm. We entered the jungle and, while the tigers went on sleeping, I asked them to walk and to discover the beautiful and the ugly things that were to be found there, those that nourished and those that did harm; that is to say, to integrate metaphorically the jungle-world totality, with its positive and negative aspects. Once again, I formulated a post-hypnotic suggestion that this process of exploration and discovery would continue through their dreams.

During the fifth session, each of them recovered beautiful things that the other had given them. Elena recounted that Pablo had helped her to improve the chaotic relationship she had previously had with her parents. Pablo remembered how Elena had urged him to carry on with his studies.

On this occasion, I used the rehearsal technique. I asked them to construct a scene in which they would feel the way they wanted to be. Both of them constructed scenes in which they were alone. We repeated the exercise with different scenes and, in the last ones, each of them came to place themselves in the same physical space as the other, but separate, carrying out different activities: each reading their own book in the living room, both travelling by car along the road, “each absorbed in their own affairs”.

I was thus able to realise that the moment had not yet come for them to learn another way of interacting. The flowers were already two independent plants and were beginning to recover. The tigers went on sleeping.

In the sixth session, we first put fertiliser on the plants, to give them still more strength, and then we moved on to the jungle. The tigers were awake by now, each walking on one side of the river, watching each other in silence, with the fear of interacting.

Elena recounted how she watched Pablo, his gestures, trying to guess whether he was angry with her for one reason or another, and how she feared that he might start shouting at her at any moment. She confessed to becoming very frightened when Pablo got angry: she felt him to be like a madman and dreaded that he might come to hit her. Out of this fear, Elena had for some time been keeping quiet about everything that bothered her. Pablo too watched Elena, fearing that, if he communicated his annoyances, she would withdraw or fly into a rage. Moreover, Elena forgot to take her medication several times and had an epileptic seizure.

I ended the session by asking them whether they knew how tigers learn to fight and to be well, and I suggested that they might learn it by dreaming.

The following week, the seventh session, I suggested that they observe what happened when one of the tigers crossed the river and approached the other, and that they learn from them.

Elena observed several attempts by one of the tigers to cross, and how he came back when the other growled, not wanting him to enter his territory. He finally dared to cross. The other watched him and growled all the more. When the newly arrived tiger tried to eat a piece of meat that was lying there, the other attacked him with a swipe of the paw, and the one attacked reacted by throwing himself to the ground as if he were defenceless, in an attitude of submission; then the other stopped attacking him, ate his meat and left a little of it for the newcomer. After that, they walked through the jungle and hunted together.

For Pablo, the outcome was similar: they walked together along the river looking for a new territory, and the dangers they met along the way united them… it was as if, in the jungle, it were better to be together than apart. There was some friction when each of them looked for a space to sleep and when the food was shared. They gave each other a few swipes of the paw, and now one gave way, now the other. They did not really wound each other, they recognised each other as companions, they were beginning to get used to being together. At times, one of them would move a little away, calm in the knowledge that, if he needed help, the other was nearby. I then did a rehearsal with Elena in which she shouted at Pablo, without fearing his reaction.

They arrived at the eighth session saying that Elena had shouted at Pablo several times; instead of getting angry, he laughed at seeing how Elena frightened herself by hearing herself shout. Pablo shouts much less now. Elena says she would like a couple relationship with less shouting; they had not, however, wounded each other. I tell them that when one is certain of being loved by the other, one can quarrel with the calm of knowing that after the quarrel both will go on loving each other.

Before ending the session, they looked at the flowers: they were doing well; they observed the tigers: they were still calm, well, like companions.

We decided that this was the moment to end the therapy, because the irises were now two strong and independent plants and the tigers had learnt to live together and to fight. I suggested that the processes that had been set going would continue throughout their lives, by day as by night, especially while they slept and dreamed.

Closing comments

Starting from the impossibility of rationally analysing and describing in words everything that happened in this process, I shall comment only on the points that seem to me relevant. Each reader will find in it different meanings and different riches.

The function of the symptom appeared from the very first session: “the scratches made them momentarily forget their wounds”. So that they could stop clawing at each other, those wounds first had to heal.

Throughout the therapy, two different realities were constructed, which from now on determine their affects and their interaction in another way. Before, they were fused into a single plant; now they are two separate plants, different and close. Before, they were two wounded tigers who attacked each other in order to forget their pain and who did not know how to live together; now they are two healthy tigers, who can be companions, support each other, take care of each other and cooperate.

Important processes also developed in them:

To some people, the end of the process may seem somewhat abrupt and hurried. The metaphors nevertheless indicated that the changes had already taken place; and, within the metaphor of the tigers itself, the possibility of relapse was included and adequately handled: suddenly they would give each other a few swipes of the paw, and then one of the two would give way. Finally, there was the closing suggestion that the processes that had been set going would continue — and so it was.

After the last session, two follow-up interviews were held: one at six months, the other at one year. During one of them, Elena commented: “it is horrible, but we shout at each other each time with a clearer conscience”. There have been changes in the relationship: she now makes Pablo’s breakfast in the morning and feels good about doing it, and Pablo has become untidier. On the whole they are happy and, from time to time, they dream of the tigers and the irises, recognise the jungle and take a walk in it.