119
5
ERICKSONIAN APPROACHES
TO PAIN CONTROL
The richness inherent in Ericksonian approaches to hypnosis combined
with a thorough knowledge of the field of pain control will prepare most clinicians
to be highly effective in reducing pain and suffering. The key highlight
of the Ericksonian approach is that it is cooperative and individualized
to the patient. Hypnosis is seen as an interactive approach between the therapist
and patient, and certainly not something that is “done” to the patient.
In terms of individualization, the therapist is often following the patient and
capitalizing on the strengths that he or she may have. In this view, resistance
is seen as a problem of the therapist rather than the patient. Specific to pain
control, the Ericksonian approach emphasizes what every good clinician
knows: that how a patient responds to pain has to do not only with the present
but also with the patient’s historical responses to pain, as well as anticipatory
responses likely to occur in the future. Ericksonian concepts may seem
frustratingly complex to the clinician who wants to intervene quickly with a
patient in pain. However, the process of truly listening to patients and reflecting
back to them what they need is also often simple. One way of looking at
this approach is that the patient is giving the clinician the answer to the test
before the clinician even takes it.
One chapter cannot do justice to the breadth of hypnotic suggestions for
pain relief, be they from Erickson or from any other source. A central theme
of this book is that drastically different interventional approaches are warranted
by different types of pain. Whereas acute clinical pain can respond
well to simple direct hypnotic interventions without many potential complications,
chronic pain typically requires far more intricate assessment and
intervention; the thoughtless application of hypnosis to chronic pain may
exacerbate the problem more than help it. Whereas some types of chronic pain
are held in place by the environment, lifestyle, and personality factors, other
types of chronic pain may be more a matter of some type of disease process or
ongoing nociception feeding into the patient’s suffering.
Much of this book has to do with understanding how pain and related psychological
factors cause the patient to suffer. Some chapters discuss how to
address pain and suffering that primarily requires a change in lifestyle. Most clinicians
working in pain control are anxious to have a series of suggestions that
have a direct impact on reducing the pain itself, and providing this information
is a primary purpose of this section. However, it is critical that clinicians understand
that adequately treating pain usually goes far beyond suggestions for pain
control. Again, understanding a biopsychosocial approach to pain control and
how hypnosis fits into it is far beyond the scope of this chapter and is discussed
in greater detail later in the book.
The most comprehensive and creative list of hypnotic suggestions for
pain control in the literature has arguably evolved from Erickson’s writing,
and these are the focus of this chapter. In discussing such approaches, it is useful
to understand how Erickson himself viewed hypnotic approaches to pain.
It is interesting to note that, as powerful an impact that Erickson had on the
field, his expectations for the effect that hypnosis might have on pain were
usually quite modest. Erickson viewed eliminating all pain though hypnosis
as an untenable, unrealistic goal in most circumstances. At one point, he gave
the example that an increase in scholastic test scores from 70% to 85% might
be a joyous accomplishment but that clinicians do not seem to be satisfied
with a 15% reduction in pain in their patients.
Erickson frequently wrote about a fractionalization approach to pain
reduction in which pain was gradually reduced (e.g., Erickson, 1983). Much
of Erickson’s work in hypnotic pain reduction reflected the time-honored
behavioral concept of successive approximations. Seldom did he try to remove
all pain at once. Instead, he saw pain control as being on a continuum, and
he tried to move the patient to the range of more comfort. Perhaps one of the
classic examples of this is a patient who had excruciating abdominal pain
from malignant cancer. Erickson was able to treat this by suggesting to the
patient that he would experience an irritating mosquito bite where the pain
was located. So rather than eliminating all sensation, or even all unpleasant
120 CLINICAL HYPNOSIS FOR PAIN CONTROL
sensation, he was able to substitute a more acceptable sensation for one that
the patient could not tolerate. Erickson also cited this example with a patient
who has severe breast cancer pain who was provided with the suggestion
for an annoying, minor itching-burning sensation in the sole of her foot
(Erickson & Rossi, 1979).
TYPES OF SUGGESTIONS FOR PAIN CONTROL
What follows is a series of hypnotic procedures for reducing pain that
were described by Erickson. His original description of these techniques can
be found in his book Innovative Hypnotherapy (Erickson, 1980b) as well as his
chapter in Rossi’s edited volume of Erickson’s collected papers (Erickson,
1948/1980a, Volume 4, Chapter 24).
Direct Abolition of Pain
As described previously, Erickson generally discouraged direct abolition
of pain as a type of hypnotic approach. Sweeping suggestions for the elimination
of pain go against the successive approximations of pain reduction,
which is a far more realistic way to approach this clinical issue. Also, he felt
that direct suggestions for pain control could interfere with the self-generated
solutions that arise out of indirect suggestions.
Suggestions for complete removal of pain is an approach that clinicians
should avoid, except in rare circumstances. The expectations that
clinicians put on themselves and communicate to their patients have a
great deal to do with their clinical effectiveness (Kirsch & Lynn, 1995;
Turner & Chapman, 1982); certainly, going into a patient relationship
with an expectation that one can reduce pain will potentially increase
clinical effects. However, communicating to the patient that all pain will
be removed raises hopes and expectations beyond what is reasonable and
will be of little benefit to the therapeutic relationship. Clinicians should
communicate realistic expectations to the patient; any clinician who
asserts that hypnosis will remove all pain—in even a small number of
patients—is likely being disingenuous. Even Erickson seldom reached this
benchmark in his work.
Erickson stated that direct suggestions for pain abolition could be useful
in some rare circumstances; an example of this is with major surgery.
Hilgard and Hilgard (1975) reported more than 20 different types of major
surgery that have been done with hypnosis as the sole anesthetic. The majority
of these cases likely used direct suggestions for the elimination of all pain.
It is also likely that the majority of these patients were highly hypnotizable.
ERICKSONIAN APPROACHES TO PAIN CONTROL 121
A clinical scenario in which direct suggestions for pain relief, not necessarily
total pain elimination, come into play is the intensive care unit
(ICU). In the ICU typically there is a narrow window of time to work with
patients before confusion or drug effects dominate their conscious presentation.
With a reduced sensorium, patients are often incapable of grasping the
subtleties of indirect suggestions; they are quite literal in their thinking. Thus,
short inductions with direct suggestions are often preferable. In the ICU scenario,
the suggestions actually can be targeted to pain elimination, but it is
important that the patient is left with some sensation to replace pain. Stating
to patients who fear for their survival that they will “feel nothing” or “feel no
pain” might elicit death anxiety, so stating that they will “feel nothing but
comfort” is preferable. As such, in the ICU situation, it is far preferable to
make suggestions along the lines of “you will feeling nothing but comfort and
complete relaxation.”
Permissive Indirect Hypnotic Abolition of Pain
Erickson was more comfortable making suggestions for complete abolition
of pain when they were done in a permissive rather than direct fashion.
His writings did not describe exactly how he would recommend doing this for
pain, but, of course, he wrote volumes on permissive, indirect approaches.
This would often involve the use of questions, which Erickson believed would
stimulate patients’ searching into their unconscious resources. An example
of this might be, “And you don’t know exactly how the pain will be suddenly
eliminated, do you?” Beyond this example, it is difficult to describe permissive,
indirect suggestions, because they are much more a matter of the entire
interaction with the patient rather than a matter of a few statements. As
described earlier, when the cooperative approach is used, the entire process
is designed to elicit problem solving from the patient. This involves not only
the use of questions but also utilization and other techniques to draw upon
the patient’s resources.
Amnesia
An increasingly popular drug that is used during brief threatening medical
procedures is midazolam (Versed), which has no impact on pain itself but
can be administered before a medical procedure as an amnestic. Patients are
conversant and cooperative while the medical team is at work, but they come
out of the procedure with no recall and no pain, providing that no tissue damage
has occurred. If a patient goes through a surgery on Versed alone, he or
she will wake up in pain from the residual trauma to the body. At its best, hypnotic
suggestion can work in a similar manner. Erickson pointed out that
122 CLINICAL HYPNOSIS FOR PAIN CONTROL
more threatening or emotionally salient events can cause patients to forget
their pain. Certainly, this can pertain to a soldier in a combat situation, which
has gained recognition as a concept through Beecher’s (1959; see also Melzack
& Wall, 1965, 1973) work. As mentioned in an earlier chapter, Hoffman and
colleagues have reported that patients sufficiently captivated by an immersive
virtual reality environment seem to forget about their pain (Hoffman, Doctor,
Patterson, Carrougher, & Furness, 2000; Hoffman, Patterson, & Carrougher,
2000; Hoffman, Patterson, Carrougher, & Sharar, 2001).
Erickson advised that such amnesias can be partial, selective, or complete.
There is a wide range of wording that can be used to accomplish
amnesic suggestions, such as, “And wouldn’t it be interesting if you found
yourself so absorbed in your comfort that you seemed to forget about everything
else?” Or, “I am wondering how it would feel if several hours passed and
all you seemed to remember is how pleasant you seemed to feel during that
period?”
Analgesia
Analgesia has to do with reducing pain, and it captures most drugs used
to treat pain, such as aspirin, nonsteroidals, and opioid analgesics. Like this
class of drugs, hypnotic analgesic suggestions reduce pain rather than eliminate
it. Like amnesia, suggestions can be partial, complete, or selective.
Analgesic suggestions are often accomplished by introducing sensory modifications
to the patient: “Perhaps you will be pleased to notice feelings of growing
warmth and heaviness in your back.” Or, “You may find that the only
thing you are able to notice is a deep, profound relaxation, and everything
else seems to go away.”
Anesthesia
Anesthesia is the elimination of pain. Erickson was seldom in favor of
using such suggestions, just as he did not usually recommend the total abolition
of pain. Common anesthetics such as lidocaine work by numbing an area,
with the hope of eliminating any sensation of pain.
Glove anesthesia is a common hypnotic suggestion and can be used in
this context. The patient might be told,
And as I continue talking with you, notice if you begin to feel a sensation
in your right hand here where I am lightly touching it. It is as if
your skin is becoming covered with an electrician’s thick leather
glove, an increasing feeling of numbness. You might remember the
sensation of your hand falling asleep and that is what seems to be happening
now.
ERICKSONIAN APPROACHES TO PAIN CONTROL 123
Once a glove anesthesia is accomplished, this sensation can be moved
to different parts of the body. The line between anesthesia and analgesia can
become difficult to distinguish at this point, but ultimately, the distinction is
not important.
Hypnotic Replacement and Displacement of Pain
As discussed earlier, Erickson was fond of replacing or changing a sensation
rather than trying to eliminate pain altogether, so this category of suggestions
is one that typified his work. Erickson offered a nice example of how
he provided suggestions for replacement or substitution of pain to a patient
with cancer:
For example, one cancer patient suffering intolerable, intractable cancer
pain responded most remarkably to the suggestion of an intolerable, incredibly
annoying itch on the sole of her foot. Her body weakness occasioned
by the carinomatosis and hence inability to scratch the itch rendered this
psychogenic pruritus all absorbing of her attention. Then hypnotically,
there were systematically induced feelings of warmth, of coolness, of heaviness
and of numbness for various parts of her body where she suffered pain.
And the final measure was the suggestion of an endurable but highly
unpleasant and annoying minor burning-itching sensation at the site of her
mastectomy. This procedure of replacement substitution sufficed for the
last six months of the patient’s life. The itch of the sole of her foot gradually
disappeared, but the annoying burning-itching at the site of her mastectomy
persisted. (Erickson & Rossi, 1979, p. 134)
Hypnotic Displacement of Pain
Erickson liked to use the displacement technique to transfer pain from
an area of the body that was perceived as threatening by the patient to one
that was less so. One example he gives is of treating a man with intractable
abdominal pain from cancer. Given that the patient perceived that the pain
in the abdomen could destroy him, experiencing pain in his left hand was far
more acceptable to him. For the 3 remaining months of his life, the patient
experienced pain in his hand rather than his abdomen, and Erickson (1980b)
reported that this promoted his functioning and relationship with his family.
It is well understood in the cognitive–behavioral literature that changing
the nature or location of pain facilitates the patient’s perception of control
of pain overall. Any time a patient is able to change qualities of the pain
experience, this will likely lead to improved pain control because to change
pain sensations is to exert at least some control over them. Thus, when
patients are successful in changing their pain through hypnotic suggestions,
124 CLINICAL HYPNOSIS FOR PAIN CONTROL
it has the benefit of enhancing the patients’ sense of control; such control,
in turn, can lead to the ability to create other sensory modifications.
Hypnotic Time and Body Disorientation
Patients who have experienced chronic pain for extended periods of
times may have difficulty remembering periods when they were pain free; this
is also the case in people with long-term depression. Patients experiencing
very severe, untreatable pain lose all perception of what it is like to be pain
free. In such cases, Erickson recommended orienting patients to periods in
their life when they were either pain free or when the pain was certainly less
of an issue. Patients do have such memories and resources within them, and
accessing them can be a powerful form of pain control. Having patients return
to such an earlier time to access such resources and then having them bring
them to the present can be a very powerful technique. Similarly, patients can
also be trained to imagine a future in which their pain is absent or more manageable.
A later chapter presents a technique in which resources from the past
are tied to images of comfortable functioning in the future.
Body disorientation was another type of suggestion discussed by
Erickson, and it is likely that such suggestions will often be limited to highly
talented hypnotic patients or to those who are in so much pain that dissociative
tendencies begin to come easily as a way to escape.1
Thus one woman with the onset of unendurable pain, in response to
posthypnotic suggestions, would develop a trance state and experience
herself as being in another room while her suffering body remained in her
sickbed. This patient explained to the author when he made a bedside
call, “Just before you arrived, I developed another horrible attack of pain.
So I went into a trance, got into my wheelchair, came out into the living
room to watch a television program, and left my suffering body in the
bedroom.” And she pleasantly and happily told about the fantasized television
program she was watching. Another such patient remarked to her
surgeon, “You know very well, Doctor, that I always faint when you start
changing my dressings because I can’t endure the pain, so if you don’t
mind, I will go into a hypnotic trance and take my head and feet and go
into the solarium and leave my body here for you to work on.” The
patient further explained, “I took a position in the solarium where I could
see him (the surgeon) bending over my body, but I could not see what he
was doing. Then I looked out the window, and when I looked back he
was gone, so I took my head and feet and went back and joined my body
ERICKSONIAN APPROACHES TO PAIN CONTROL 125
1Excerpt reprinted from The Collected Papers of Milton Erickson on Hypnosis: Vol. IV. Innovative Hypnotherapy
(pp. 242–243), by M. H. Erickson (E. L. Rossi, Ed.), 1980, New York, NY: Irvington. Copyright 1980 by
the Erickson Foundation. Reprinted with permission.
and felt very comfortable.” This particular patient had been trained in
hypnosis by the author many years previously, had subsequently learned
autohypnosis, and thereafter induced her own autohypnotic trance by
the phrase, “You know very well, Doctor.” This was a phrase that she
could employ verbally or mentally at any time and immediately go into
a trance for the psychological–emotional experience of being elsewhere,
away from her painful body, there to enjoy herself and remain until it was
safe to return to her body. In this trance state, which she protected very
well from the awareness of others, she would visit with her relatives, but
experience them as with her in this new setting while not betraying that
personal orientation. (Erickson, 1980b, pp. 242–243)
Hypnotic Reinterpretation of a Pain Experience
Reinterpretation of a pain experience has become a hallmark of
cognitive–behavioral treatment of pain. In fact, in sociocognitive conceptualizations
of hypnotic pain control, there seems to be little difference between
altering such cognitions and hypnosis (T. X. Barber, Spanos, & Chaves, 1974;
Chaves, 1989; Chaves & Barber, 1976; Spanos & Chaves, 1989a, 1989b,
1989c). Inducing hypnosis is not even regarded as necessary for such suggestions
to be useful (Chaves, 1993). In the cognitive–behavior literature, catastrophizing
has become a central concept in pain control. Catastrophizing refers to excessively
negative thoughts about the meaning of pain. If a patient experiences a
pain sensation and is convinced that it will lead to his or her death, or can never
be changed, those thoughts will have a great deal to do with how he or she is
able to cope with that pain. Modifying such cognitions can reduce pain, and such
modifications can certainly be done in the context of a hypnotic induction.
Burn pain, one of the most intense and difficult-to-treat forms of nociception,
provides a good example of how reinterpretation of sensations
becomes particularly salient with burn injuries. It is well known that fullthickness
burns are not necessarily painful because the depth of the tissue
damage is severe enough to destroy the function of nerve endings. As full or
partial thickness (i.e., second-degree) begin to heal, it is common for skin
buds to appear on the epidermis. Such buds are extremely sensitive to touch
and pain. This leads to some important reinterpretive messages to patients,
both in and out of hypnosis. Patients can be told that the presence of skin
buds is a sign of healing and the return of viable, nonscarring skin. It might
very well suggest that the patient will heal without the need for a skin graft.
This is excellent news for the patient, and while it may not make the pain go
away, it certainly casts a more positive light on it.
This leads to a concept that is critical in the chronic pain literature: the
difference between hurt and harm. If patients experience pain and believe that
126 CLINICAL HYPNOSIS FOR PAIN CONTROL
it is harming them, their reaction will often be to guard themselves and
restrict movements. Decreased movement typically leads to biomechanical
problems and disuse syndromes that will only worsen chronic pain, but ultimately
may be the only factors that keep it in place. If patients can be convinced
that the pain they are experiencing, while hurting them, is not causing
harm, this has profound implications for their participation in rehabilitation.
Certainly, this is where a thorough medical workup is essential, because pain
is often indeed a warning signal, and suggesting movement when protection
is necessary can worsen the problem.
One of the better examples of reinterpretation of pain sensations came
from a nurse working with patients with amputation pain. She explained to
them that phantom limb pain or sensations can be overwhelming at first.
However, she likened these experiences to going camping along a noisy creek.
Initially, all one hears is the sound of the water, but eventually the sounds
tend to move into the background of perception. Inherent in this suggestion
is that phantom sensation is part of the hurting that goes with amputation
and is no longer serving any type of warning or functional purpose.
Hypnotic Time Distortion
Erickson cited Cooper (Cooper & Erickson, 1959) as being one of the
first to report time distortion techniques for pain control and discussed one
compelling case as an example. A patient presented with “intractable attacks
of lacerating pain” that occurred day and night for periods of 5 to 10 minutes,
every 20 to 30 minutes. Between each episode, the patient lived in dread of
the next attack. The patient was taught amnesia for the periods of the attacks.
He was then taught to experience all of the pain in a 10- to 20-second trance
state and then to forget that this might have happened. Thus the patient
would be talking to his family, would go into a trance state, would scream in
pain, and then would resume his conversation as if nothing had happened. It
is interesting to note that, as discussed earlier, there was no attempt to eliminate
all of this patient’s pain.
Time distortion can be an effective suggestion for chronic pain, particularly
when combined with confusion and amnesia. A patient may be told,
Some time in the future—it might be a few hours from now, or perhaps
a few days—you will look back and be surprised at the amount of time
that you have been in a comfortable state, maybe initially that will be
only for a few minutes, or maybe it will actually be a few hours. You
might also find that the times during which you are in pain simply
seem to shrink rapidly. What once seemed to be an hour will seem like
10 minutes or even 10 seconds. We have all had the experience of
being so wrapped up in a wonderful activity that time seems to fly by,
ERICKSONIAN APPROACHES TO PAIN CONTROL 127
and that is how it will seem, only the periods in which you are comfortable
will just seem to slow down. Ultimately, you will look back
and be amazed that you have difficulty remembering the last time you
actually experienced pain.
Hypnotic Suggestions Affecting a Diminution of Pain
For patients who are not fully responsive, Erickson recommended suggestions
for diminution of pain—specifically, that the pain would diminish
imperceptibly, hour after hour, without the patient’s awareness. He argued
that suggesting that the pain diminished imperceptibly made it harder for the
patient to refuse what occurred in hypnosis. He stated that the diminution of
the pain (or parts of the pain) would not be noticeable, that a 1% reduction
would not be noticeable, nor would a 2%, 3%, 4%, or even 5% reduction.
Over sessions, the amount of pain reduction is increased, but in gradual increments
that are designed to be imperceptible to the patient.
Patients often respond well to the concept of a “dial” or “rheostat” that
they can use to turn down their pain in an imaginative sense. They can be
given the suggestion that there is a dial on their abdomen, back, or other part
of their body, and that by turning down the dial they are able to reduce their
pain, much like they are able to with a dimming light switch.
Metaphors/Interspersal Technique
Erickson’s use of metaphors to deliver suggestions, an approach that he
often called the interspersal technique, was discussed in the previous chapter.
In brief, suggestions for pain control are embedded in the context of a story
or narrative. Erickson’s most famous pain metaphor was reported with his
treatment of a florist with terminal cancer pain and is reprinted below.2
The author began: “Joe, I would like to talk to you. I know you are a
florist, that you grow flowers, and I grew up on a farm in Wisconsin and
I liked growing flowers. I still do. So I would like to have you take a seat
in that easy chair as I talk to you. I’m going to say a lot of things to you
but it won’t be about flowers because you know more than I do about
flowers. That isn’t what you want. (The reader will note that italics will be
used to denote interspersed hypnotic suggestions, which may be syllables,
words, phrases, or sentences uttered with a slightly different intonation.)
Now as I talk and I can do so comfortably, I wish that you will listen to me
comfortably as I talk about a tomato plant. That is an odd thing to talk
128 CLINICAL HYPNOSIS FOR PAIN CONTROL
2Excerpt reprinted from The Collected Papers of Milton Erickson on Hypnosis: Vol. IV. Innovative
Hypnotherapy (pp. 269–271), by M. H. Erickson (E. L. Rossi, Ed.), 1980, New York, NY: Irvington.
Copyright 1980 by the Erickson Foundation. Reprinted with permission.
about. It makes one curious. Why talk about a tomato plant? One puts a
tomato seed in the ground. One can feel hope that it will grow into a
tomato plant that will bring satisfaction by the fruit it has. The seed soaks
up water, not very much difficulty in doing that because of the rains that
bring peace and comfort and the joy of growing to flowers and tomatoes.
That little seed, Joe, slowly swells, sends out a little rootlet with cilia on
it. Now you may not know what cilia are, but cilia are things that work to
help the tomato seed grow, to push up above the ground as a sprouting
plant, and you can listen to me Joe so I will keep on talking and you can
keep on listening, wondering, just wondering what you can really learn, and
here is your pencil and your pad but speaking of the tomato plant, it grows
so slowly. You cannot see it grow, you cannot hear it grow, but grow it
does—the first little leaflike things on the stalk, the fine little hairs on
the stem, those hairs are on the leaves too like the cilia on the roots, they
must make the tomato plant feel very good, very comfortable if you can
think of a plant as feeling and then, you can’t see it growing, you can’t feel
it growing but another leaf appears on that little tomato stalk and then
another. Maybe, and this is talking like a child, maybe the tomato plant
does feel comfortably and peaceful as it grows. Each day it grows and grows
and grows, it’s so comfortable Joe to watch a plant grow and not see its
growth not feel it but just know that all is getting better for that little tomato
plant that is adding yet another leaf and still another and a branch and
it is growing comfortably in all directions. (Much of the above by this time
has been repeated many times, sometimes just phrases, sometimes sentences.
Care was taken to vary the wording and also to repeat the hypnotic
suggestions. Quite some time after the author had begun, Joe’s wife
came tiptoeing into the room carrying a sheet of paper on which was written
the question, “When are you going to start the hypnosis?” The author
failed to cooperate with her by looking at the paper and it was necessary
for her to thrust the sheet of paper in front of the author and therefore in
front of Joe. The author was continuing his description of the tomato
plant uninterruptedly and Joe’s wife, as she looked at Joe, saw that he was
not seeing her, did not know that she was there, that he was in a somnambulistic
trance. She withdrew at once.) And soon the tomato plant
will have a bud form somewhere, on one branch or another, but it makes
no difference because all the branches, the whole tomato plant will soon
have those nice little buds—I wonder if the tomato plant can, Joe, really
feel a kind of comfort. You know, Joe, a plant is a wonderful thing, and it
is so nice, so pleasing just to be able to think about a plant as if it were a
man. Would such a plant have nice feelings, a sense of comfort as the tiny
little tomatoes begin to form, so tiny, yet so full of promise to give you the
desire to eat a luscious tomato, sun-ripened, it’s so nice to have food in one’s
stomach, that wonderful feeling a child, a thirsty child, has and can want
a drink, Joe is that the way the tomato plant feels when the rain falls and
washes everything so that all feels well. (pause) You know, Joe, a tomato
plant just flourishes each day just a day at a time. I like to think the tomato
ERICKSONIAN APPROACHES TO PAIN CONTROL 129
plant can know the fullness of comfort each day. You know, Joe, just one day
at a time for the tomato plant. That’s the way for all tomato plants. (Joe
suddenly came out of the trance, appeared disoriented, hopped upon the
bed, waved his arms and his behavior was highly suggestive of the sudden
surges of toxicity one sees in patients who have reacted unfavorably to
barbiturates. Joe did not seem to hear or see the author until he hopped
off the bed and had walked toward the author. A firm grip was taken on
Joe’s arm and then immediately loosened. The nurse was summoned. She
mopped perspiration from his forehead, changed his surgical dressings,
and gave him, by tube, some ice water. Joe then let the author lead him
back to his chair. After a pretense by the author of being curious about
Joe’s forearm, Joe seized his pencil and paper and wrote, “Talk, talk.”)
“Oh yes, Joe, I grew up on a farm, I think a tomato seed is a wonderful
thing, think, Joe, think in that little seed there does sleep so restfully, so
comfortably a beautiful plant yet to be grown that will bear such interesting
leaves and branches. The leaves, the branches look so beautiful, that
beautiful rich color, you can really feel happy looking at a tomato seed,
thinking about the wonderful plant it contains asleep, resting, comfortable,
Joe. I’m soon going to leave for lunch and I’ll be back and I will talk some
more. (Erickson, 1980b, pp. 269–271).
SUMMARY
A premise of this book is that directly focusing on pain reduction during
hypnosis may not always be the best way to facilitate the patient’s comfort and
well-being. Using hypnosis to change the patients’ lifestyle, encourage him or
her to move therapeutically, or simply improve his or her sleep may ultimately
have the strongest impact on the well-being of a patient reporting chronic pain.
However, there are many instances in which focusing on pain can be of tremendous
benefit, particularly if the pain is driven by some type of lesion or ongoing
nociceptive signals. Even if the goal is to get at lifestyle changes of the patient
or underlying dynamics that are driving the pain, using hypnosis to increase
comfort can increase rapport and invest the patient in the more comprehensive
treatment process that is often necessary to control pain.
It is interesting to note that the creative list of hypnotic analgesic suggestions
developed by Erickson seldom had the purpose of eliminating pain.
Rather, the goal of his suggestions was usually to change the perception of
pain and gradually reduce rather than eliminate it. What we still do not know
is what type of suggestion is going to work with a given patient at a particular
time. The several types of creative suggestions offered by Erickson can be
put in a multiple-choice format as is consistent with indirect suggestions.
130 CLINICAL HYPNOSIS FOR PAIN CONTROL