This month’s “Perspective” features a pair of reprinted articles, originally published in the The Milton H. Erickson Foundation Newsletter [Summer 1997, Vol.17, No.2].
Hyperemesis Gravidarum:A Single-Session Hypnotic Intervention
By David O. Navarre, LMSW-ACP Austin, Texas
Susan reported nausea and vomiting throughout her first pregnancy, to the point where she was bedridden for the third trimester. However, she had successfully carried a healthy child to term. Pregnant a second time, she was experiencing nausea and vomiting and was becoming concerned about the progressive severity of her condition. She was adament she did not want a pregnancy similar to her first.
Although she had no previous experience with hypnosis, she was referred by a friend who had a successful hypnotic experience, and she had a strong desire to resolve her problem. She also was curious about what was causing it.
The method I selected was based on a personal variation of the hypnotic approach pioneered by Ernest Rossi, Ph.D. I suggested her therapy would center on asking her unconscious mind basic questions about the source of her discomfort and what she needed to do to be relieved.
I asked Susan to hold her palms facing each other, approximately 6 to 10 inches apart, and to focus her attention on her hands. I continued the induction, using a series of truisms, to establish an abbreviated ‘yes’ set, leading to a dissociation permitting ideomotor responses from her unconscious. “As you focus your attention on your hands, imagine that they are like magnets … If the answer to the question I am aboaut to ask you is ‘yes,’ your hands will be attracted to each other. If you answer is ‘no,’ your hands will be remain where they are or be pushed further apart.” I instructed her to not to use her conscious ability but rather to allow her hands to respond “all by themselves.” I asked, “Is your unconscious mind willing to look for the source of this condition?” Her eyes remained open and fixated as she studied her hands for a response. As they drew closer together, I again reminded not to consciously influence the movement of her hands; simultaneously I encouraged her to notice any other sensations in her body or thoughts, images or emotions she might be experiencing in her “minds’ eye.”
Once her hands touched, I suggested that response to the next question would be indicated by experiencing weight shifts in her hands. If the answer was ‘yes,’ one hand would become heavy and slowly move to her lap. In the answer wa ‘no,’ one hand would become lighter and raise. I asked, “Is your unconscious mind willing to have the courage to explore the source of this problem?” Her answer was ‘Yes.’
I ratified her responses with minimal verbal replies. Crucial to this approach is that the therapist avoid “talking too much,” thus allowing the client to provide the most pertinent and individual responses possible. I did encourage her to maintain concentration with her internal experience while facilitating her verbal responses. Periodically, when I noticed behavioral responses, I would ask her, “What are you aware of now?” At one point she said she saw a beautiful yellow colour.
During her internal exploration, Susan understood that her nausea and vomiting were related to her fears, along with her feelings of powerlessness and of being unable to shape the outcome of the infant’s growth within her. An unusually heavy sigh, coupled with an apparnet inward contemplation suggested satisfaction with her discovery.
At this point I asked a third question. “Is your unconscious mind willing to explore a solution to htis problem of nausea and vomiting?” As she again indicated an ideomotor response of agreement, she remarked she continued to see the most beautiful bright yellow color. Furthermore, she laughed with pleasure as she said htat when she saw this color, she felt very comfortable and the nausea went away.
She was guided through the process of exploring how seeing the beautiful yellow color alleviated her nausea nad created comfort for her as well as the feelings of discomfort she had when she wasn’t seeing it. This was repeated several times to anchor the response and to give Susan a feeling of powerfulness over her nausea. Susan remarked she was “amazed” at how comfortable she could feel and that it “was so simple.” She said she intended to surround herself with this colour, wear yellow clothing and add yellow to the decor in her bedroom.
Coincidentally, as she was leaving, I noticed the mail pile on my desk included a small bright yellow envelope. I tore a piece from the envelope and told her to carry it with her and look at if she ever felt nauseous. Several months later, I received a yellow “thank you” card from her with a picture of her newborn son.
By Mickey Skidmore, ACSW
While some clinicians may be discouraged with an “alleged”” waning of interest in Ericksonian approaches (e.g. Zeig, 1994), single-session interventions such as this rejuvenate my pride, exhilaration and resolve in referring to myself as an Ericksonian therapist. Cases such as these show that Erickson’s contributions continue to cascade down to new generations of health care practitioners.
While there are numerous aspects of an Ericksonian approach depicted in this Case Report, perhaps the most noteworthy is Navarre’s variation of Rossi’s approach. It has been said frequently and in a variety of ways that Milton Erickson did not practice Ericksonian psychotherapy (Zieg, 1994). I know personally that Rossi himself encouraged Navarre to write about cases in which he used ‘Navarrian’ therapy. In my view, the author’s approach clearly incorporates a rich variety of Ericksonian principles.
One could say the induction began before Susan’s actual session. She had no previous hypnotic experience, strong positive expectations, an a strong desire to learn about her problem. This, as well as her strong motivation for treatment, created a desirable set-up any therapist would relish. Moreover, the experience of Susan’s friend contributed to the development of a quick rapport.
Navarre began the “formal induction” with truisms, development of a ‘yes’ set, and facilitated a conscious/unconscious disassociation which those familiar with Ericksonian methods will recognize.
I imagine Rossi would be heartened by the creative adaptation in this Case Report. Navarre maintained the essential structure of Rossi’s approach while including hes own personal innovations. While Rossi historically preferes to employ pathways stressing mind-body communication, the author’s course engaged ideomotor responses to unconscious processing. Rossi’s three step intervention essentially inquires first, if there is an issue or problem. Second, there is a history or review of the problem and finally, a future orientation or exploration of learning and/or solutions to the problem (Rossi, 1992 & 1993).
Navarre first focuses on the source of the problem and asks Susan’s unconscious to indicate willingness to search for the source. Susan then was encouraged to begin to explore this. Finally, Navarre facilitated unconscious work which “solved” the problem. Those familiar with Rossi’s work will see similarities, yet Navarre’s incorporation of his unique style illustrates the endless possibilities to such an approach.
Navarre concludes this session by anchoring the solution provided by Susan’s unconscious with he senses of relief, empowerment and pleasure. This procedure provided closure to successful piece of therapeutic work. Further anchoring occurred with Navarre’s creative use of the yellow envelope on his desk. The success of this case is validated by her reciprocal use of yellow in the birth announcement.
This case presents perhaps the fundatmental hallmark of Erickson’s teaching — to embody one’s own abilities, skills and expertise within the umbrella of Ericksonian principles. Nvarre shares his personal variation of Ericksonian approaches in this case. More importantly, I believe he successfully demonstrates how Erickson continues to influence new generations of therapists.
Rossi, E. “The Psychobiology of Mind-Body Healing” Houston Texas 1992 training seminar.
Rossi, E. The Psychobiology of Mind-Body Healing: New Concepts of Therapeutic Hypnosis (revised edition) New York: Norton 1993.
Zeig, J. (Editor) Ericksonian Methods: The Essence of the Story. New York: Brunner/Mazel, 1994.