Ericksonian Hypnotherapy For the Treatment of Addiction

Dr. Milton Erickson, who died in the 1980s, was widely acknowledged as a leading practitioner of medical hypnosis. However, Dr. Erickson’s individual approach to psychotherapy and his early contribution to the understanding of Neuro Linguistic programming (NLP) is less well-known.

The essence of Erickson’s technique was his gentle induction of the client into an hypnotic trance. Erickson’s use of reframing (where metaphors such as “challenge” are substituted for “problem”) and his use of tasking, where a client is engaged in activity prescribed to surface hidden resources, reflected his belief that individuals possess an extraordinary level of unacknowledged and unrecognized personal resources.

Unfortunately, hypnosis has long suffered from the suspicions of the uninformed and its usage has been inhibited to the prevention of smoking and a limited range of habit disorders. The limited research that has been carried out has found that hypnosis when used as a technique in the treatment of addictive behavior, facilitates greater self control and self discipline. It also disrupts the usual pattern of behaviors, thus allowing the intervention of healthier alternatives originating from the sub-conscious mind and bringing with it a deeper level of emotional satisfaction for the client.

Client referred to me are usually in a state of considerable disarray. Therapy begins immediately with the gathering of sensory specific information combined with constant reframing together with creative visualization and hypnosis to reduce stress levels.

Tasking has been used extensively by therapists to restrict alcohol intake and in an attempt to change established habits. Individuals pass through a number of recognisible stages in their decision to break a damaging habit, namely:

Pre-contemplation:
The individual seeks information about the harmful effects of consuming alcohol. Sometimes the risk is acknowledged but there is no serious wish to change.

Contemplation:
The individual possesses, and has considered, the relevant information but needs further facts on harm, cost and reasons to change.

Action / Maintenance:
The individual attempts to reduce alcohol consumption but may need considerable support.

Significant changes to harmful and destructive behaviours can be accomplished through hypnotherapeutic reframing of specific event via age regression, incorporating the client’s need at appropriate cognitive emotional levels, unification of ego states by way of arm levitation and building anticipation for a successful present and future by pseudo orientation in time methods.

To illustrate this procedure, the following case study features the broader principles of the Ericksonian technique which have been adapted to treat addictive behaviour.

“Mr. R, a 28 year old married man with two children, was referred to me by his psychiatrist. His presenting problems included a long history of drug and alcohol abuse, resulting in drug related legal problems, combined with long-standing marital difficulties. He lacked self esteem and self-confidence, had no real goals in life and was unable to relax.

The client was in a depressed and lethargic state, frequently referring to his lack of energy and ongoing lack of success.

The treatment plan was essentially twofold:

1. The psychiatrist supplied 60 mg of Methadone per day and also performed relapse prevention.

2. I provided Ericksonian hypnotherapy coupled with cognitive behavioural therapy, which highlighted the client’s denial of alcohol related problems and his lack of assertiveness.

Reframing began by exploring his skills base. The subtle use of a possible frame helped identify several skills related to his trade of carpentry.

Hypnosis and the use of arm catalepsy suggested strength and direction whilst the hypnotic state immediately reduced the client’s fear level. During hypnosis, I used a metaphor involving a wise old man. As the client’s trance deepened, ‘Wise Old John’ bestowed a gift which was secret between himself and the client. This metaphor appeared to have a positive effect on the client.

During the latter part of the therapy I employed several NLP techniques including a six step reframe, from which optimism and self esteem began to emerge.

Self hypnosis appeared to blunt Mr. R’ excessive craving whilst the reality of his former condition continued to be addressed in a positive cognitive behavioural manner.”

It remains to be seen whether Mr. R progress can be maintained but he has to date remained free of drug and alcohol abuse. This is particularly significant as prior to treatment he allegedly could not sustain a period of 18 hours without resorting to the fuse of alcohol or drugs. The client’s relationship with his wife has also improved and he is more confident and assertive.

Not every case presented to me has such a successful outcome, relapses and disappointments being a fact of life. There has, unfortunately, been a rapid increase of addictive incidence and somewhat ‘hit and miss’ rates of success. In my own experience physical, psychological and social deprivation are commonalities of drug and alcohol abuse but added to these are the personal traumas and emotional need drives of the individual. The “traditional” treatments of psychotherapy, counseling and detoxification have their vital role but the disappointing rates of success suggest these boundaries should be further expanded. Significantly, those few who have successfully followed the Ericksonian routes were themselves rejects of these conventional treatments. I look forward with optimism to a gentle break through for some others!

Anger Management – Information and Treatment

Chronic anger is a growing problem in America reaching epic proportions. A therapeutic treatment method that has gotten a lot of press is called anger management. This type of treatment is often conducted in the format of group psychotherapy. Through group dynamics such as effective communication modeling, assertiveness role- playing, and problem solving skills training, clients will garner new skills, will learn to find outlets to let off steam, and will have self-efficacy in their ability to navigate their world and the natural anger feelings that arise.

The interesting part of treating venomous anger is that you are sometimes treating other issues, as well, such as personality disorders (e.g., Anti-social and Borderline personality disorders), you may have clients with Bipolar disorder, clients whom have been through a horrific trauma, or clients with adjustment issues. All of these facets may be considered in anger treatment.

A big motivator for change in anger clients is the recognition of the costs of anger/aggression. Often there are severe consequences to clients’ anger issues including problematic or lost relationships, problems at work, legal issues, and others. Clients need to understand that what they have been doing to cope with anger has not worked for them. Chances are their methods have actually driven them away from the very things that are most meaningful to them. This recognition sets the stage for behavioral change. Additionally, anticipation of consequences is a powerful management tool.

We teach basic principles through psychoeducation early in the treatment process. For instance, it is important to note that anger is normal feeling. However, this normal feeling can turn problematic when anger becomes aggressive behavior.

There are two different types of aggression that I want to discuss: passive anger and aggressive anger.

Passive anger tends to be expressed with manipulation, secretive behavior, self-critical thoughts, suicidal ideation, and other modes. Passive anger is often not recognized because there are no apparent outbursts or exhibitions.

The more widely recognized form of anger problem, aggressive anger,has very different symptoms, such as demonstrated acting out, revenge seeking behavior, violence, and other forms.

In my anger treatment methodology, I target 4 main areas of aggression.

  1. Physical aggression toward others (e.g., physical fights and altercations).
  2. Verbal aggression toward others (e.g., yelling, screaming, arguments, threats)
  3. Aggression toward property (e.g., breaking things, throwing things, punching holes in walls)
  4. Aggression toward oneself, or aggression turned inward. This is the realm of self injurers such as self-injury (e.g., cutting, suicide attempts). These people often say “I’m not angry, I’m just depressed”.

Another concept in anger treatment is the recognition that aggression is a choice we make. I want to help my clients and group members begin to develop a sense of responsibility as well as an internal locus of control. Also we will practice being empathic, that is, understanding situations from others perspectives, stepping out of our own shoes.

Another portion of treatment is the recognition that anger is almost always a secondary emotion. There are numerous underlying “primary emotions” that drive anger. These include fear, shame, guilt, frustration, feeling disrespected, hurt from abuse, and many others. The work we do on the primary emotions is important for a couple of reasons:

  1. We begin to process some inner conflicts and painful experiences, even early in life, that have contributed to our personality development, our view of ourselves, and the way we conceptualize relationships and the world around us.
  2. We glean insight into our own personal sensitivities, or triggers, so that we become aware of warning signs, then let off steam by means of communication or stress reduction activities, before we explode.

Another important aspect of anger management is addressing the tendency of many clients to hold onto bitterness and hostility for an unhealthy period of time. This has many negative consequences on the person’s physical health and often keeps patients in a stuck position. We need to learn acceptance through forgiveness (for ourselves, not the other person) through mindfulness skills practice empathy training, behavioral techniques, and values clarification.

What to Expect When a Partner Is Healing From Trauma or Alcoholism

There are many types of marriages. One type that I am often asked to help is the Healing Marriage. In this type of marriage the couple is involved in a relationship to help one or both heal from childhood traumas. Sometimes these couples form their relationship based on helping each other. Other times they are surprised that their relationship evolves this particular way. These couples have an ability to tolerate dysfunction, as long as they know their spouse is on a path of healing.

In Healing Marriages, the hope to provide a safe, loving place that is far different from the traumatic background one, or both, came from is very strong. It is possible they may trust each other enough to create a shared vision based on this hope. They work very hard together to prevent repeating old childhood patterns. They look toward each other for motivation and inspiration. If they have children they may work especially hard on parenting, becoming the 50% who do not repeat abusive parenting – even becoming extraordinary parents.

At difficult times the healthier spouse is able to provide an exceptional amount of love, nurturing, support, and patience. Often, greater degrees of closeness, attachment, and commitment are the rewards. Enormous growth is possible in these relationships. That growth can be further enriching for the couple. At some point in time the marriage then is able to shift focus from healing to enjoying each other and their life together.

Another type of Healing Marriage is one that is recovering from alcoholism. It is especially helpful to couples recovering from alcoholism to be informed about what to expect in the healing process. Couples healing from alcoholism, or other addictions, need to know they will be creating a new, different, and better life; not just putting their life back together. This will require reaching outside the relationship for help. A 12-step program, a therapist, and/or church can be important to help the couple tolerate the uncertainty that will come from so much change. The couple needs to know this turmoil is normal. They need to know that the psychological separation that occurs is not only normal, but also necessary. This separation allows the couple to become healthy as individuals first, so that they can become healthy together, as a couple. This process can take a long time.

At the same time, if there are children, the couple needs to both be able to attend to the children, as well as focus on self. This can be difficult to pull off. Treatment providers are beginning to realize that children can become neglected in the recovery process. Providers are beginning to consider ways to balance treatment to consider the children’s needs. One way is to ensure that the children have outside support also.

Apologies can be an important step that may be needed in healing from trauma, alcoholism, affairs, or others difficulties. Taking responsibility for one’s mistakes, making a sincere apology, and offering amends, are important abilities that measure one’s honesty, character, integrity, caring, maturity, and self-esteem. AA teaches these skills in its 12-Steps of Recovery. They are skills everyone could benefit from learning. What is not included in the 12-steps, or other self-help resources is Part Two in the process of apology. I call it the “bearing up phase”. This means, after the apology has been offered —”I did it, I was wrong, I am sorry I caused you pain” – the apologizer must fortify himself to bear up to hear the injured person’s hurt and anger. The nature of the injury will determine the intensity of the feelings that the one apologizing will have to withstand, and the time necessary to process through those feelings. Some injuries, such as those of affairs, or abuse, could take a long time. Being able to listen with patience, fortitude, care, empathy, and sorrow is important. Both parties involved with difficult injuries will likely need help to endure and stay with the process. Without help, too often the one responsible for the injury is unable to tolerate the other’s pain, and preempts the process by becoming defensive. In addition, the wronged party may need help expressing his feelings of being wronged constructively. If the process is allowed to unfold through all the feelings, then true forgiveness will be the likely outcome. Reconciliation may be possible as well. Smaller injuries, of course, are more quickly and easily laid to rest.