An exploratory outcome comparison between an Ericksonian approach to therapy and brief dynamic therapy

American Journal of Clinical Hypnosis,  Jan 2008  by Simpkins, C Alexander,  Simpkins, Annellen M

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Abstract

The purpose of this study was to determine whether an Ericksonian approach to therapy using hypnosis (ET) was as effective as brief dynamic therapy (BDT), a long-standing and well-researched form of psychotherapy. The study used a comparative pretest/posttest design with four paper and pencil tests [Clark Personal and Social Adjustment Scale (CPSAS), Hopkins Symptom Checklist (HSCL), Target Complaint (TC), and Global Improvement (GI)] and six therapy sessions. The investigators attempted to choose design features that would not interfere with the unique qualities of ET while maintaining empirical regularity. No statistically significant difference was found except on HSCL where ET was superior. An interesting finding was that without direct discussion of the target complaint, ET brought about the same improvement on targeted problems as BDT. ET subjects reported gaining understanding of their problems as much as BDT subjects, but from a different source. The results of this study are a step toward empirical confirmation of ET as an evidence-based treatment alternative for psychotherapy.

Keywords: Clinical hypnosis, therapeutic effectiveness, efficacy in hypnosis, non-specific factors, utilization, unconscious, indirect suggestion.

Milton Erickson has had a profound effect on the field of hypnosis and psychotherapy. A large body of anecdotal literature now exists describing his successful treatments (Zeig, 2006b, 2003,1983; Erickson & Rossi, 2006,2006a, 2006b; Haley, 1985 a, b, c, 1973; Erickson & Keeney, 2006; Short, Erickson & Erickson, 2005; Battino, 2005; Lankton, 2004; Simpkins & Simpkins, 2004,2001a, 2000; Yapko, 2003, 2001; Haley & Haley, 2003), to name just a few. With more than 120 Erickson Institutes (www.ericksonfoundation.org) treating clients and two-thirds of them in countries outside of the United States, Ericksonian theory and methods are being used worldwide.

Literature Pro and Con

Not everyone agreed with Erickson during his lifetime or over the decades following his death. For example, Hilgard held a well-researched, but different view on susceptibility (Hilgard, 1967). Social role-playing and sociocognitive theories reinterpreted the notions of the hypnotic state or an unconscious mind (Sarbin & Coe, 1972; Barber 2000; Kirsch & Lynn, 1995, Lynn & Sherman, 2000). Interest in Erickson's work has also generated critics who questioned Erickson's claims (Mathews & Edgette, 1997). Thoughtful rebuttals and useful interpretations such as from Lankton, (Mathews & Edgette, 1997, Lankton & Lankton, 1983) and Gilligan (Mathews & Edgette, 1997; Gilligan, 1987) answered some of these objections and proposed useful modifications for integrating Erickson's ideas into modern practice.

Even though Kuhn (1962) believed the real work of science begins when a community of scientists adopts a paradigm, Lynn and Rhue (1991) point out that the field of hypnosis continues to remain divided about which paradigm is best. But regardless of disagreements and division, a growing and respected body of research shows that clinical hypnosis is effective for varying problems (Lynn & Kirsch, 2006), and there is a general trend toward validation of hypnotherapy (Alladin, Sabatini, & Amundson 2007).

In Popper's influential interpretation of science (Popper, 1959), scientific progress results from a combination of innovative, creative theories and careful research. Milton Erickson was a creative innovator who left a legacy for psychotherapy. His method for therapy using hypnosis is certainly worthy of careful research.

Purpose

This study was intended as an exploratory step to test the efficacy of an Ericksonian approach to therapy using hypnosis (ET) as a primary treatment method for short-term psychotherapy. The investigators attempted to create a research design that would adhere to as rigorous empirical standards as possible without interfering with the individualistic, nonstandard methods used by Erickson.

Brief dynamic therapy (BDT) was compared to ET in order to have a distinctive contrast. Also, BDT has been validated as a possibly efficacious therapy (Chambless et. al., 1998). Comparing a new therapy with a possibly efficacious or efficacious treatment is one of the design methods suggested by APA for efficacy studies (Chambless et. al, 1998).

Definitions

Psychotherapy Effectiveness

The effectiveness of psychotherapy is defined as the change in four dimensions: social/ environmental, internal/experiential, target problem, and global improvement. Four instruments were used to measure this change: Clark Personal and Social Adjustment Scale (CPSAS), Hopkins Symptom Checklist (HSCL), Global Improvement (GI), and Target Complaint (TC).

Ericksonian Therapy (ET)

ET is defined as a form of psychotherapy using hypnosis and originated by Milton Erickson. As used here, ET refers to the five-stage paradigm of the dynamics of trance induction and suggestion introduced by Rossi in 1976 consisting of 1) fixation of attention, 2) depotentiating habitual frameworks and belief systems, 3) unconscious search, 4) unconscious processes, 5) hypnotic response (Erickson & Rossi, 1979; Erickson & Rossi 2006b). This 5-stage paradigm includes less traditional methods of problem solving exemplified in the published works of Milton Erickson (Erickson & Rossi, 2006). More specifically, ET is typified by the use of utilization technique (Erickson and Rossi, 2006a, 2006b; Zeig, 2006a; Short, Erickson, & Erickson-Klein, 2005; Erickson 1965,1959), therapeutic binds (Erickson & Rossi, 1975), indirect suggestion (Erickson & Rossi, 1976), confusion technique (Erickson, 1964), therapeutic stories (Erickson & Keeney, 2006, Rosen, 1982), naturalistic induction (Erickson, 1958b), and especially, the use of many of these techniques in combination. ET does not rely on conscious insight.