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Ericksonian approaches to
hypnosis and therapy: Where
are we now?
William J. Matthews a
a
University of Massachusetts ,
Amherst Published online: 31 Jan
2008.

To cite this article: William J. Matthews (2000) Ericksonian approaches to hypnosis

and therapy: Where are we now?, International Journal of Clinical and Experimental
Hypnosis, 48:4, 418-426, DOI: 10.1080/00207140008410370
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 EKICKSONIAN APPROACHES TO
HYPNOSIS AND THERAPY:
Where Are IHe Now?
WILLIAIvf}. MAITMEWS’
u i ii) /Massacfiusetls-AmMrst

Abstract: Ericksonian approaches to psychotherapy and hypnosis

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have had a significant impact on many clinical practitioners over the

last two decades. This article reviews the current empirical research
with regard to the efficacy of these treatment approaches as well as for
the key Ericksonian assumptions of: (a) belief in an altered state of con-
sciousness and the existence of specific markers indicating an altered
state; (b) the superiority of indirect suggestion over direct suggestion;
and (c) client hypnotizability is a function of the hypnotist's skill. The
current literature provides empirical support neither for efficacy nor
for these key assumptions. The article concludes with a discussion of
the need for empirically based research to test the efficacy of
Ericksonian therapy and its core components, lest this approach
become isolated from the scientific hypnosis and therapy communities.

The work of Milton Erickson (1901-1980) has provided significant

markers on the hypnotic landscape for at least the last half of this cen-
tury. Erickson's ideas about psychotherapy (of which his use of hypnosis
was a significant part) have contributed to the development of a
number of different therapeutic approaches (e.g., brief therapy, strategic
therapy, solution-focused therapy, neuroliriguistic programming, and, Of
course, Ericksonian hypnosis itself). There are numerous Ericksonian
Institutes in the United States, Europe, and Australia; hundreds of books
pub- lished; and annual national and international conferences detailing
clin- ical interventions directly derivative of Erickson's ideas.
In a questionnaire by Rodolfa, Kraft, and Reilley (1985) to 500 mem-
bers of the American Society of Clinical Hypnosis, 161 professionals,
including physicians, psychologists, and dentists, with a mean age of
50 years, returned the comp leted survey. The authors reported
that:
(a) Erickson was the respondents' clear choice in terms of a specific
theo- rist with whom they most closely identified in their work; (b)
Erickson was preferred in their sample population by a ten to one
ratio; and

Address correspondence to William J. Matthews, Ph.D., School Psychology

Program, University of Massachusetts-Amherst or shamrock&educ.umass.edu.

The International Journal of Clinical and Cxperimeiital Hypnosis, Vol. 48, No. 4, October 2000 418-426
°O 2000 The Inteimat tonal Joumol of Clinical and Experimental Hypnnsis

418
 CLINICAL FORUM 419

(c) respondents selected Erickson as the most pervasive influence of

any contributor in the field of hypnosis.
Similarly, the survey reflected the popularity of Ericksonian hypnosis
in its influence in a wide range of applications, such as behavioral medi-
cine, choice of reading materials, training seminars attended, and research
interests. In this survey, two books were cited as most representative of
the hypnosis field, with the Advanced Techniques of Hypnosis and Therapy:
Selected PapOYS OJ Milton H. EricRoti, M.D. (Haley, 196a) ranked first,
fol- lowed by Clinical and Experimental Hypnosis (Kroger, 1963).
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Although the survey by Rodolfa et a1. (1985) may reflect sampling bias,
it is consistent with the common observation of Erickson's signifiCililt
influence on the field. That Erickson's ideas about hypnosis and
psychotherapy have had an impact on the professional psychological
community, there can be lit- tle doubt. However, now 20 years after
Erickson's death, it is legitimate to ask: (a) has the technique identified as
Ericksonian hypnosis been estab- lished as efficacious, and (b) what
empirical support exists for the under- lying core constructs of this
approach?

Assessing £Jcncy
Is hypnosis effective as a clinical intervention? Kirsch, Montgomery,
and Sapirstein (1995) performed a meta-analysis on 18 studies in which
cognitive-behavioral therapy with and without hypnosis was analyzed.
Their results indicated that treatment outcome is significantly enhanced
by the addition of hypnosis. Their data showed a 70% greater improve-
ment by those clients receiving cognitive-behavioral hypnotherapy, as
compared to subjects receiving nonhypnotic cognitive-behavioral ther-
apy. Kirsch et al. concluded that the effect of adding hypnosis to psycho-
therapy is substantial for a broad range of presenting problems.
Although the Kirsch et al. meta-analysis supports the effectiveness of
cognitive-behavioral-based hypnosis,2 what of Ericksonian hypnosis?
It is often stated by many clinicians that clinical research trials are
arti- ficial, contrived situations that do not reflect real world clinical
prac- tice, which should be, of necessity, naturalistic and self-correcting
(Silberschatz, 1999). The importance of being naturalistic, self-correct-
ing, and clinically flexible is particularly valued by Ericksonian-oriented
therapists (e.g., Edgette & Edgette, 1995; Gilligan, 1987; Lankton &
Lankton, 1983; Matthews, Lankton, & Lankton, 1993). Ultimately, the
necessity of self-correction by the therapist in relationship to client
response, the importance of being clinically flexible, and the effective-
ness of utilizing the client's clinical presentation are empirical questions.
Randomized clinical trials, even with inherent methodological limita-
tions, are an effective method to determine clinical efficacy,
effectiveness,

'Hypnosis in conjunction with cognitive-behavioral therapy has been designated as a

probably efficacious treatment by American Psychological Association, Division 12.
 and to provide component analysis of complex treatment packages,
(Jacobson & Christensen, 1996).
To date, I am aware of no research on Ericksonian therapy (with
or without the use of hypnosis) that would meet the
criteria(AmericanPsy- chological Association Task Force on
Psychological Intervention Guide- lines, 1994) of an empirically
validated treatment.° The lack of outcome research on effectiveness,
coupled with the reliance on clinical anecdote or uncontrolled single-
case study common in the Ericksonian literature, have created
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inescapable limitations for Ericksonian hypnotherapy in determining

its efficacy and effectiveness. Let us consider the empirical literature in
regard to the key assumptions that underpin Ericksonian hypnosis.
Assessing Three Core Constructs of EricRonion Hypnosis
As I have discussed elsewhere (Matthews, in press; Matthews,
Conti, & Starr, 1998), there are three basic assumptions that underlie
Ericksonian hypnosis. These assumptions are: (a) hypnosis is an altered
state of consciousness with markers that are distinguishable from the
waking state; (b) hypnotizability of the subject/client is primarily a
func- tion of the hypnotist's skill (i.e., utilization strategies) and less a
function of the subject/client’s hypnotic ability and; (c) the use of
indirect hyp- notic suggestion is, at least in some instances, more
effective in produc- ing hypnotic responses than is direct suggestion. Let
us consider the empirical support for each of these assumptions.
Hypttosis as a sfsfe. Milton Erickson was a strong proponent of the
altered state position (Erickson & Rossi, 1979, 1980b; Haley, l96Z), as
were a number of his followers (e.g., Dolan, 1991; Edgette & Edgette,
1995; Gilligari, 1987; Lankton & Lankton, 1983; Matthews, 1985, to
name but a few). Within this view, the altered state of consciousness is
produced by some form of hypnotic induction in responsive persons
and is distin- guishable from other altered states. Although suggestibility
is a charac- teristic of this altered state, it is not the only distinguishing
characteristic. Sarbin and Slagle's 1979 review of the literature on
physiological correlates of the hypnotic state considered a wide range of
research on respiratory, cardiovascular, hemodynamics, vasomotor,
genitourinary, gastrointestinal, endocrine, and cutaneous functions.
These authors conclude that: (a) there is simply no evidence that
physiological changes in the aforementioned functions are attributable
to a hypnotic trance state, and (b) such physiological changes can be
influenced by stimula- tion conditions, symbolic processes, and
imaginings (p. 300). Careful and systematic empirical reseamh has
failed, at least as yet, to yield any

Although there are a plethora of case studies and anecdotal reports, there are few em-
pirical studies on Ericksonian approaches in the literature (cf. Nugent, 1989, 1993; Otani,
t989).
 consistent replicable physiological indicator of a hypnotic state (Kirsch
& Lynn, 1995; Sarbin & Slagle, 1979). However, as Kirsch and Lynn
point out, there could be an indicator of state yet to be identified. For
example, the recent work by Barabasz et al. (1999) on cortical event-
related poten- tials is suggestive of physiological markers of hypnosis
(cf. Crawford, 1990, 1994).
Related to the notion of hypnosis as a state, within the Ericksonian
model, is the emphasis on the construct of the unconscious mirid (e.g.,
Erickson & Rossi, 1979, 1980b; Lankton & Lankton, 1983). During
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hyp- notic induction or the intervention phase of hypnosis, this notion

isoften expressed to the client in phrases such as “trust your
unconscious mind.” From the Ericksonian perspective, a wise unconscious
mind pro- vides the basis by which the client may be able to develop
solutions not available to the conscious mind (Erickson & Rossi, 1980a;
Lankton & Lankton, 1983). Simply stated, there is precious little
evidence for a “wise” portion of the unconscious in which solutions
unavailable to the conscious mind can be generated.
H notizabilifi as a function of the hypnotist's skill. In the
Ericksonian paradigm, essentially all individuals have the ability for
hypnotic responding. The essence of achieving this responding lies in
the individ- ualizing of the hypnotic technique and the skill of the
hypnotist, and per- haps an overly broad definition of hypnotic
behavior. Trait theorists (e.g., Brown & Fromm, 1986; Hilgard, 1965;
Kihlstrom, 1985; Orne & Dinges, 1989; and Spiegel & Spiegel, 1978)
maintain that the ability to experience hypnosis exists primarily within
the person, not the hypno- tist. As Kirsch and Lynn (1995), in their
review of the trait debate, stated,
There is ample support for the hypothesis that hypnotic responsiveness
is a trait-like, aptitudinal capacity of the person. Different measures of
hypnotizability are moderately to highly intercorrelated, typically in ex-
cess of .60, and a test-retest correlation of .71 has been reported for a retest
interval of 25 years. (p. 849)
Hilgard (1982) stated, “The main source of the belief held by many prac-
ticing clinicians that everyone is hypnotizable is a confusion between
the success of their psychotherapy arid the role of hypnosis in it” (p.
398).
(ndirect and direct suggestion. Although Milton Erickson was no
stranger to the use of direct suggestion(Hammond,1984) in his
hypnotic approach, he has perhaps become most celebrated for his use
of indirec- tion (i.e., indirect suggestion, puns, metaphors, anecdotes,
etc.) in the process of hypnosis and hypnotic induction. Erickson
(Erickson & Rossi, 1980b) suggests that indirect suggestion has utility
in helping the client to access unique potential and earlier life
experiences, as well as being a method by which to bypass conscious
resistance. In a series of studies comparing direct and indirect
hypnotic inductions on hypnotic respon- siveness, Matthews and
colleagues (Matthews, Bennett, Bean, &
 Gallagher, 1985; Matthews &: Isenberg, 1992; Matthews & Mosher, 1988)
consistently failed to demonstrate the superiority of indirect suggestion
over direct suggestion in a laboratory setting. In a comprehensive
review of the available data comparing direct and indirect suggestion
on hyp- notic responsiveness, Lynn, Neufeld, & Maré (1993) conclude
that
The best controlled studies provide no support for the superiority of
indi- rect suggestions, and there are indications that direct suggestions
are su- perior to indirect suggestions in terms of modifying subjects'
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experience of hypnosis. Nevertheless, the overriding conclusion is that

differences be- tween a wide variety of suggestions are either
nonexistent or trivial in na- ture. (p. 138)

CONCLUSION
The question at the outset of this piece asks with regard to
Ericksonian hypnosis and its use in psychotherapy, “Where are we
now?” The research reviewed simply does not support long-held
beliefs by Erickson or those who practice Ericksonian approaches to
therapy. There is no definitive evidence for a trance state, the existence
of a wise uncon- scious, the importance of indirect over direct
suggestion, or the univer- sality of hypnotizability. Although there are
impressive and dramatic clinical anecdotes cited in the literature
about Erickson and his work, there is no compellirig need to invoke
any sort of special curative pro- cesses active in Ericksonian
approaches beyond those already docu- mented as active in any form of
effective psychotherapy (e.g., relation- ship, expectancies, construction
of a compelling narrative, active client involvement). Unlike hypnosis
as an adjunct to cognitive-behavioral therapy, it is not clear that
hypnosis adds anything to this approach.
At this point, one might ask, “What is the future of Ericksonian hyp-
nosis and psychotherapy?” The answer is at best uncertain. Due to the
lack of empirical research for either the components of Ericksonian ther-
apy or outcome evaluation as compared to other interventions. One may
disagree, for example, with the statement that indirect suggestion is not
more effective than direct suggestion. Howeverr tile burden is on the
claimant to provide refutable empirical evidence in support of a given
hypothesis. In the absence of data, one is left with only personal belief
and clinical anecdote. In the absence of careful scientific evaluation, I
fear that Ericksonian approaches to hypnosis and psychotherapy will
become further isolated from the scientifically based hypnosis and ther-
apy communities.
The parallel to psychoanalysis seems all too real. Freud eschewed sci-
entific evaluation of his constructs, exclusively employed the case study
method, and, as such, was subject to his own repeated confirmatory
biases. As a result, traditional psychoanalysis became isolated from
emerging discoveries in psychology, cognitive science, and neurosci-
ence. Its status within mainstream scientific psychology was (and still is
 to a degree) at peril. To a limited extent, recent and solid
psychoanalytic process/outcome research has rescued
psychoanalysis from what appeared to be its fate (Luborsky, 1984;
Malan, 1995; and Strupp & Binder, 1984). Happily, there is nothing in the
writings of Erickson to suggest he was at all opposed to scientific
validation of his ideas as was Freud (ct. Crews, 1998; Sulloway, 1992).
At this juncture, however, it is imperative that Ericksonian theorists
begin the process of generating and empiri- cally testing hypotheses
that address if, when, how, and for whom Ericksonian approaches
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work. To do anything else is to risk irrelevance.

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 CLIMICAL FORUM 425

Ericksons Hypnose- und Therapiemethoden: Der heutige Stand William J.

Matthews

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methoden haben in den letzten zwei Jahrzehnten viele Wille, frnn
klinische Thera peuten deutlich beeinflusst. Der
vorliegende Artikel untersucht die derzeitige
empirische F orsc hung zu m einen unter dem As pekt der
Wi rk sam ke it dieser Therapiemethoden und zum
anderen in bezug auf die Hauptannahmen, auf denen die
ericksonsche Therapie beruht: (a) Annahme eines
verä nderten Bewusstseinszustands und das
Vorhandensein von spezifischen Markern, die einen
verä nderten Bewusstseinszustand anzeigen; (b)
Ü berlegenheit von indirekten Suggestionen ü ber direkte
Suggestionen; und (c) die Auffassung, dass die
Suggestibilitä t des Klienten eine Funktion der Kompetenz
des Hypnotherapeuten ist. Durch die gegenwärtige
Forschungsliteratur werden weder diese Hauptannahmen
noch deren Wirksamkeit empirisch gestü tzt. Der Artikel
schließt mit einer Diskussion der Notwendigkeit von
empirisch gestü tzter Forschung zur Ü berprü fung der
Wirksamkeit der ericksonschen Therapie und ihrer
zentralen Komponenten, um eine Ausgrenzung dieser
Methode aus der wissenschaftlichen Hypnose- und
Therapiefachgemein- schaft zu verhindern.
ROSEMARIE GREENMAN
ldniversity of Tennessee, Knoxville,
TN, LISA

Les approches ericksoniennes en

hypnose et er thérapie: où en
sommes-nous maintenant?

William J. Matthews

Résumé: Les approches ericksoniennes en psychothérapie

et en hypnose ont eu un impact si Bnificatif sur beaucoup
de praticiens cliniques pendant les 2 dernières décennies.
Cet arti cle passe en revue la recherche empirique actuelle
pour ce qui concerne l'efficacité de ces approches de
traitement
comme acceptations principales ericksoniennes: ta)
croyance dans un état modifié de conscience et l'existence
des repères spécifi ques indiquant un état modifié; (bl la
supériorité de la suggestion indirecte par rapport de la
sugges- tion directe; et (c) que le hypnotisabilité du client
est fonction de la compétence de l'hypnothérapeute. La
littérature actuelle ne fournit le support empirique ni pour
l'efficacité ni pour ces pré tentions principales. L'article
conclut par une discussion autour du besoin de la
recherche empiri que basée sur le fait de tester
l'efficacité de la thérapie ericksonienrie et de ses com
posantes central es, de peur que cette a pproc he rie s is
ol e des communautés scientifiques d'hypnose et de
thérapie.
ViC SIMON
l?sychosamalic Medicine H
Clinical Hyp›zosis frislif ute,
 426 WILLIAM J. MATTHEWS

Enfoques Ericksonianos a la hipnosis y la terapia:

¿En qué situació n nos encontramos?

William J. Matthews

Resumen: Los enfoques Ericksonianos a la psicoterapia y la hipnosis han

tenido un impacto importante en muchos profesionales clínicos en las ú ltimas
2décadas. Este artículo revisa la investigació n empírica actual con respecto a
la eficacia de estos enfoques de tratamiento así como las suposiciones claves
Ericksonianas de: (a) la creencia en un estado alterado de consciencia y la
at 20:14 10 November 2014

existencia de ciertos marcadores específicos que indican dicho estado; (b)

la supremacía de las sugestiones indirectas sobre las directas; y (c) que la
hipnotizabilidad del cliente depende de la habilidad del hipnotista. La litera-
tura actual no provee apoyo empírico ni para la eficacia de estos enfoque ni
para estas suposiciones claves. El artículo concluye con una discusió n sobre la
necesidad de una investigació n basada empíricamente para someter a prueba
la eficacia de la terapia Ericksoniana y sus componentes claves, para evitar que
este enfoque se aísle de las comunidades científicas hipnó tica y terapeú tica.
ETZEL CARDEÑ A
University of Temas, Pan Am
McAllen, Texas, USA
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