Journal of Cognitive Psychotherapy: An International Quarterly, Volume 10, Number 3,1996

Ericksonian Approaches to
Psychotherapy: From Objective
to Constructed Reality
William J. Matthews
University of Massachusetts

Psychotherapy historically has operated within an expert model context.

Within this frame, patients present their symptomatology to the therapist
expert for diagnosis and intervention. The work of Milton Erickson has
offered an alternative perspective in which the idea of the problem is shifted
from one of pathology to one in which the individual's strengths and
resources are utilized. This paper discusses the Ericksonian approaches from
a postmodernist narrative perspective. Ericksonian hypnotherapy is consid-
ered from this epistemological frame, particularly the role and value of
expectancy in creating a new therapeutic narrative.

When thinking about therapy, change, and Milton Erickson, I am reminded of a

story. One of Erickson's medical students married a very attractive woman and on
his wedding night could not produce an erection. Prior to this relationship the man
had acquired quite a reputation for sleeping with many women. Regardless of his
previous successes, for 2 weeks after the wedding he could not produce an erection.
He tried everything, including masturbation, all to no avail. Thus, 2 weeks after this
understandably dismal honeymoon, his new wife consulted a lawyer about an
annulment. The young man consulted Erickson.
Erickson chose to see both the man and the woman, albeit individually. While
her husband waited outside, Erickson listened to the wife's sad and disappointing
story. As might be expected, she was quite angry, bitter, and upset. She perceived
herself to be attractive. Yet on her wedding night her husband was incapable of
making love to her. Erickson knew, of course, that the wedding night has a
significant and powerful meaning as it ritualistically marks the transition into a
particular aspect of adulthood. The situation was overwhelming in its importance
to the young wife and Erickson defined it to her in this manner.
After listening intently and with sensitivity, he then asked her if she had thought
about the compliment her husband had given her. Erickson reported the woman as

© 1996 Springer Publishing Company

205
206 Matthews

looking puzzled at this point as his question would seem to be in contradiction to

what she had described. "Well," said Erickson, "evidently he thought your body was
so beautiful that he was overwhelmed by it. Completely overwhelmed. And you
misunderstood that and felt he was incompetent. And he was incompetent, because
he realized how little capacity he had to really appreciate the beauty of your body.
Now you go into the next room and think that over" (Haley, 1973, p. 157).
Erickson then proceeded to call the husband in and hear his sad story of the
honeymoon. Erickson reiterating the point he had made earlier with the wife,
indicated the significant compliment he (the husband) had given her. In his
discussion with the man, Erickson offered that he (the husband) had a great deal of
guilt about previous affairs but here was his incapacity proving to his new wife that
he had found the one right woman, the overwhelming woman. Erickson reported
that they drove home together, almost stopping the car on the way to have
intercourse, and they were successful from then on.1
During a lecture to a group of medical students, one of the students, in a hostile
and aggressive manner, interrupted to both berate Erickson and denounce hypnosis
while challenging Erickson to hypnotize him. The student then apologized to
Erickson for his behavior and stated that he was in the process of developing a
migraine for which nothing could be done and in approximately 15 or 20 minutes
he would begin projectile vomiting after which he would need to be taken home. He
indicated no medical treatment had been successful. The student asked, however,
if he could stay at the lecture as long as possible. Erickson agreed to the request
while challenging him to try hypnosis in the absence of any other successful
intervention. The student reluctantly agreed saying, "Well, I've nothing to lose but
my breakfast, so go ahead with your silly hypnosis" (Erickson & Rossi, 1980, vol.
4, p. 253).
The student was then asked to take a seat in front of the class facing the author
with his back to the class. He was instructed to slowly rotate his chair until he had
made a complete turn of 360 degrees. As he gradually rotated the chair, Erickson
explained to the class that each little movement would become slower and more
difficult. Erickson further explained to the class that the subject could take his time
and with each movement of the chair he would feel increasing fatigue, and
sleepiness. Eventually the chair would be so difficult to move that he would stop
trying to do so and simply relax by going into deep trance. All of Erickson's
suggestions were heard as explanations made to the class, not commands directly
given to this hostile and challenging subject.
By the time he was facing the audience, he had developed a deep trance. Erickson
then informed him that, he (Erickson) was in charge of him and that all instructions
were to be followed. The subject nodded affirmatively. He was then instructed to
awaken, speak in negative manner about hypnosis and Erickson. Furthermore he
was to declare that hypnosis made him sick to his stomach. Erickson told him that
he should try to prove that statement by going to the window, opening it, and trying
to vomit projectilely, but that he would fail completely.
Erickson and Constructed Reality 207

The subject awakened, spoke in the derisive manner suggested, opened a

window and did his best to vomit and failed, stating,"By this time I should have lost
the lining of my stomach, but I'm beginning to feel better. I always vomit when I
am about to have a migraine and I sure had all the warning signs this morning. But
if I can't vomit, perhaps I won't have it (the migraine)" (Erickson & Rossi, 1980,
p. 254). Erickson responded to this statement explaining that many problems
regardless of origin frequently follow specific patterns of behavior and a disruption
of the patterns can often be quite therapeutic.
Finally, Erickson challengingly asked the subject if he now believed in hypnosis
and did he dare to volunteer as a subject. The subject responded that while he
initially thought hypnosis to be nonsense that perhaps he was beginning to think that
Erickson could hypnotize him. He then expressed some confusion about what had
happened to his headache. He stated, "I knew this morning when I woke up that I
was going to have one, and when I came into this classroom I was in my usual,
helpless, ugly mood. But now I feel fine" (Erickson & Rossi, 1980, p. 254).
Erickson stated, "It's all very simple, and as I explained, you will go into a trance,
a deep trance, remember everything, and then awaken, knowing that you never need
to have another migraine headache. So rouse up" (Erickson & Rossi, 1980, p. 54).
The client awakened from the trance that developed and had a total recovery of all
events.
Milton Erickson made significant contributions to the field of psychotherapy,
particularly in conceptualizing how clients and their presenting issues might be
considered. He differed radically from the predominant view of his time (a view that
continues to a large extent in the present) which implies that problems are the result
of a cause-effect process and insight about the underlying cause(s) is a necessary
precursor to change. Erickson discounted the necessity for insight in relationship to
therapeutic change. Instead he focused on the day-to-day realities of the client's life,
and sought to utilize clients' strengths rather than focus on their weaknesses as away
to bring about change (Erickson & Rossi, 1980, vol.4). With a range of therapeutic
techniques such as stories, hypnosis, paradoxical tasks, etc., Erickson invariably
created a positive expectancy for change and helped clients construct more useful
stories or narratives than those with which they came into therapy.
In this article, the underlying epistemological shift from a linear/Newtonian
view to a socially constructed perspective of therapy and the basic principles of
Ericksonian therapy within this constructivist frame will be discussed.

PSYCHOTHERAPY: INVENTION VERSUS DISCOVERY

When a medical doctor meets with a patient there is a clear philosophical underpin-
ning for their interaction. The physician seeks specific information from the patient
in order to form a specific diagnosis and concomitant intervention. When a
psychotherapist meets with a person who may be identified as patient or client, not
a meaningless designation in itself, what is the essence of this interaction? The
208 Matthews

analogy to the medical context, while used historically, may not be particularly
useful as we consider psychotherapy in the postmodernist era. The postmodernist
epistemology discounts the notion of objective truth independent from the observer
in favor of a constructivist idea that truth (i.e., reality) is created or invented by the
observer in interaction with a given context.

Traditional Epistemological Underpinnings of Therapy

The term "psychotherapy" has important implications for both the practitioner and
the recipients. Psychotherapy suggests healing, curing, or otherwise intervening in
the psyche of the individual. Embedded within this view has been the belief that the
problem, in some fashion, exists within the client. This intrapsychic notion of the
problem is in contrast to the view held by Milton Erickson and many subsequent
family therapists who see problems existing as a interaction between people as
differentiated from within a person.
As a basis for comparison, let us briefly consider the epistemological foundation
that has shaped the historical development of most therapy (and Western society in
general).
Truth exists and can be known
Observing carefully will reveal the truth
Hierarchy is necessary and inherent within the system
Observers are separate from the observed
Reductionism increases descriptive usefulness
Labeling of parts is a banal event
Problem-oriented—identify linear causes of current problem
Past-oriented—causes of current problem lay in the past
Individuals operate independent of environment
Problems are intrapsychic
Experts give treatment.
The above list of underlying principles of most psychotherapy is, in essence, a
narrative (i.e., a story) designed to explain some aspect of our experience, in this
case, our experience of psychotherapy. How did this view of the world evolve? A
major thesis of Ludwig Wittgenstein's writings is that the limits of our language (our
narrative) create the limits of our experience. Our possibilities as humans are
opened or limited as a function of the stories we use to describe our experience (i.e.,
the glass is half full or half empty). In order to understand traditional psychological
concepts of deviance, depression, anxiety, etc. and engage in psychotherapy, it
would seem necessary to understand the prevailing narratives that invented these
concepts as a way to define them differently. For example, in the earlier story of the
newly married couple, Erickson defined the man's impotence as a compliment to
his new wife who misunderstood the significance of such a compliment. Erickson
created a new narrative from the existing set of "facts."
Erickson and Constructed Reality 209

Our vocabularies that describe "facts" clearly have changed over time, allowing
a wide range of variation and agency in human experience. In Western civilization,
we have passed through seven significant eras which defined how we determined
our experience, early Greek period, early Christian period, the Dark Ages, the Age
of Enlightenment, the Age of Romanticism, the Modern period, and our current
postmodern or poststructural period.2 Each era provided a way, i.e., a story line, to
define human understanding of the world.
For example, in reaction to the horror and oppression of the Dark Ages in which
humankind was beset by evil spirits and demonic possession, the Age of Enlight-
enment invented the idea of logic and intellect as a basis of understanding. Intellect
was that which separated us from other animals and nature. With the idea of
separation from nature comes the belief of domination and control over nature and
each other. Much of this Cartesian-dominated view continues to inform our current
reality.
By the middle of the 20th century, the Age of Modernism, we shifted our frame
of understanding the unfathomable, unknowable idea of the human interior in-
vented by individuals of the previous Romantic period, such as Freud and Jung, to
the metaphor of humankind as a scientific machine, i.e., that which is knowable,
measurable and responsive to external input. In this frame, our interior life does not
consist of dark, instinctual impulses requiring repression and/or sublimation but of
an inherently positive identity of humanness which is ultimately knowable to
ourselves and others. Maladjustment for the individual reflected the narrative of
each defining period. In the age of enlightenment, maladjustment was manifest in
the expression of irrational thought, in the romantic period our conscious mind was
overwhelmed by unconscious irrationality, while in the modernist period malad-
justment became the loss of connection with our true core identity.
In the postmodernist period, our human vocabulary shifts from the language of
objective reality to one which constructs reality. Which is to say, all that can be
known can be known only from a perspective and context (H. Goolishian, personal
communication, October, 1988). As such, our identity is developed in relationship
to a perspective which could be cultural, ethnic, gender-based, etc. The modernist
notion of getting back in touch with our "true selves" is replaced with the post-
modernist frame that "self is a contextually and conversationally (i.e., socially)
derived notion that can and does change over varying contexts.
This epistemological shift requires a new conceptualization of therapy. Within
this frame, therapy problems are not viewed as being out of touch, from the
modernist perspective, with our true inner identity, or as an inability to repress
unacceptable instinctual impulses in a romantic view, but rather as stories or fictions
that describe our loss of agency or choice in a particular socially constructed
context. The individual in our rapidly changing society must have the ability to
develop and master multiple stories of self within varying social contexts. A value
in this perspective for the therapist is freedom from identifying and measuring
objective reality and the resultant imposition of normative truth on clients.3 Our task
210 Matthews

with clients is to develop useful multiple narratives that allow for productive agency
within ever changing social contexts.
Within this perspective, the underlying epistemological principles of a
postmodernist narrative psychology might be described as:
Co-creation of what is considered true
Participation is all that is possible and observation is participation
Cooperative position is taken by nature
Observers are part of the system they observe
Punctuation of experience is arbitrary
Pattern identification is limited by the labeler's experience and choices
Goal-oriented—solving the task
Health-discovering—emphasis on desired resources needed for change
Future-oriented—focus of therapy lies in present and immediate future
Individuals and environments form an ecosystem
Problems are reciprocally and cyclically between parts of the system
Therapists help create a context for problem solving.
Each of the above principles provide an undergirding of an Ericksonian approach
to therapy.

ERICKSON, AND THE COGNITIVE

NARRATIVE APPROACH
In the two cases presented earlier, we can see in Erickson's interventions illustra-
tions of the above concepts. In each case Erickson did not view the situation purely
as an expert discovering the truth linked to past unresolved problems in a causal and
linear manner, instead, he became an active participant, helping create a context for
change, discovering health as it unfolds, and orienting his clients toward the current
and future goals by retrieving resources, experiences, and/or abilities needed for
change. As a result there is no negative labeling, little need for defensive resistance,
and a lower probability of an adversarial response by the client being evoked. In the
second case, where the client did express an antagonism, Erickson respected and
utilized the client's emotional style as part of the change process in redefining the
client's experience.
In describing the narrative paradigm Gon?alves (1994b) and Lakoff (1987)
stated that: (a) humans are seen as storytellers; (b) thoughts are essentially
metaphorical and imaginative; (c) the manipulation of thoughts is an intentional
pursuit of meaning; and (d) reality is seen as set of ill-structured problems that can
be accessed through hermeneutic and narrative operations. While Erickson prob-
ably would not have identified himself with the epistemological shift under
discussion,4 his work represents and, in actuality, preceded this paradigmatic shift
in the idea of therapy. There are three aspects of Ericksonian therapy that reflect this
epistemological shift to the narrative frame. They are: (1) metaphor and indirect
suggestion: (2) the meaning of the symptom and; (3) the idea of change.
Erickson and Constructed Reality 211

Recent developments in cognitive sciences suggest limitations to clients' con-

scious self-reports of their cognitive processes, thereby necessitating the need for
alternative methods to work with the tacit and analogical levels of human experi-
encing (Conceives & Craine, 1990). Metaphor, analogy, and/or stories can become
useful tools to suggest the possibility of change at this tacit or unconscious level of
cognitive representation. For Erickson, the value of such a manner of expression in
therapy was the opportunity to redirect and restructure the client's metaphors.
How, for instance, shall we suggest the experience of confidence to a client? We
might offer the general discussion (i.e., a story) of how a child riding a bicycle
around a neighborhood for the first time without training wheels comes to feel a
certain sense of exhilaration, mastery and excitement. As we elaborate in greater
detail how the child knows that experience and produces it, the therapist is pointing
the client to similar memories and experiences. The pointing, however, is indirect.
The therapist is not specifically asking the client to have or recall that particular
memory nor any memory in any particular way. The assumption of the narrative and
Ericksonian approach is that clients will, via metaphor, engage in a search for
meaning at the tacit or unconscious level and in so doing access personal experi-
ences relevant to them that will facilitate, coupled with behavioral action, more
useful constructions (Erickson & Rossi, 1979).
Direct suggestions within the hypnotic context, while often effective, are
designed by their very nature to reduce if not eliminate ambiguity for clients.
Indirect suggestions, on the other hand, promote ambiguity, such that clients will
apprehend that portion which is of subjective value to them and apply it to the
process of retrieving and associating experiences needed to reach the current goals.
Indirection offers the client an area of possible inquiry and may be Socratic,
challenging, playful or vague. Indirect suggestion assumes an active and participat-
ing client with an ability to develop new associations necessary for change to occur.
In this process, the therapeutic goal is the retrieval of useful experiential memories
and resources.
In this one idea alone, one can see the importance of co-creating experience. For
example, in preparing the client for hypnosis, the therapist might directly suggest
eye closure and such a suggestion might be effective. However, for the client for
whom such a suggestion does not fit, an indirect offering of eye closure may be more
useful. Thus the therapist might offer, "Everyone closes his eyes sooner or later, and
it would be important for you not to close your eyes until a new learning can occur.
A learning that you won't have until you feel those sensations in your eyes." Eye
closure is offered to the client at his or her own pace and linked with the possibility
of a new experience which implies a connection to the therapeutic process.
In psychodynamically oriented therapy, symptoms are seen as an indication of
an internal conflict and by definition problematic. Symptomatic presentation from
this perspective are typically viewed as ego weakness and to the lay person, often
an indication of personal failure. It is little wonder that many clients wish to find a
well-defined biological explanation with the concomitant biologically-based cure
for the symptom they or a family member displays. Biological explanations carry
less stigma (i.e., "I am not to blame for my chemical imbalances.")
2/2 Matthews

The Ericksonian view attempts to create a different narrative regarding symp-

toms. From this perspective, a symptom (the result of the client's construction of
reality) is a potential resource for rapport, communication, or possibly change and
is viewed as an attempt to solve a relevant problem with the resources currently
available to the client. The therapeutic issue is that these problem-solving attempts
are no longer satisfactory to the client or those within the client's context. Thus, the
problem is considered from an interactional perspective rather than a breakdown of
some intrapsychic management system.
Change within this approach is not based on a normative model of health but as
an individually defined goal of creatively mastering a current situation. From this
perspective, change rather than cure,5 is based on retrieving the resources within the
individual and create a shift in client expectancy that change is possible. The goal
of Ericksonian therapy is for clients to use and further develop these abilities in a
directed fashion for their own betterment. In essence, the successful client is one
who develops a new narrative to describe his or her experience, a narrative which
allows for agency or action which previously was in some way viewed as unsatis-
factorily limited.

Ericksonian Principles in Cognitive Narrative Construction

Expectancy. There are a number of underlying basic principles distinctive to an
Ericksonian approach (Lankton, 1985a, 1985b) which reflect the notion of the
socially constructed narrative. The role of client expectancy is a key element in
developing the therapeutic narrative. Kirsch (1990) makes a strong case that client
and therapist expectation for a particular outcome (i.e., behavioral change and/or
hypnotic response) are central in the therapeutic process. Erickson considered
expectancy in two ways: (1) disrupting negative expectancies; and (2) creating
positive beliefs/expectancies that change will occur (Erickson & Rossi, 1979). The
following is a brief discussion of key principles in support of changing expectancy.
Action vs. Insight. Ericksonian therapy is interested in getting clients active and
moving (Zeig, 1980). This movement must be in their lives outside the office.
Homework assignments are often given to have clients carry out agreed upon
behaviors between the sessions. Hypnotherapy and the use of anecdotes, therapeu-
tic metaphors, and indirect suggestions are ways of conversing with clients to help
create the impetus during sessions to carry out new relational behaviors or
congruently engage in the homework assignments. While it may be that change
leads to insight (Dammann, 1982), clients' understanding or insight about a
problem is not of primary importance. The matters of importance are the clients'
participation in new experiences and transactions in which the opportunity to
develop new appropriate relational patterns can occur. From action a new narrative
is developed.
Conscious/Unconscious Distinctions. Erickson spoke of the conscious mind as
a storehouse of limiting beliefs, prejudices, opinions, and biases in cases where
Erickson and Constructed Reality 213

there was a problem. He emphasized the positive unconscious in terms of a force that
could be depended upon to be working in the person's best interest, seeking health
and optimal adjustment to various situations. Clients come to therapy having
employed the most adaptive solutions available to their conscious minds and the
problem(s) persist. Recognizing that clients are making their optimal choices within
their limiting world view, Erickson typically worked to overload, bypass, confuse,
or otherwise engage the conscious mind in an effort to retrieve, organize and
associate unconscious resources to relevant contexts.6 This principle, or idea, that
the unconscious stores valuable learnings which can be used in a directed fashion
operates in all types of Ericksonian therapy, not simply in interventions featuring
hypnosis in which more formal attention is directed to communicating with the
unconscious. In all the facets of therapy, our construction is that clients come with
their conscious and unconscious minds listening. It is therefore relevant to speak to
both parts, aware of multiple levels of meaning, interpretation, and potential
responses.
Conscious/unconscious dissociation language is helpful in acknowledging the
problem-solving intention of both parts while recognizing the distinctive differ-
ences in style, method, and orientation. Erickson would typically suggest that the
client's unconscious mind can consider the presenting problem from an entirely
different perspective than the limitations imposed by the conscious mind. A difficult
option for the client to challenge if one accepts the notion of an unconscious. This
language also helps to presuppose (i.e., create an expectancy for) a wealth of
resources about which the person can feel positive even in the absence of having a
conscious awareness or control over how these resources operate.
Health vs. Pathology. As discussed earlier, in Ericksonian therapy problems are
not thought to be "inside" the person but rather the result of a difficulty of
transitioning in the developmental life cycle (Haley, 1973). Consequently, Erickson
sought to depathologize people (Fisch, 1990; Matthews, 1990). Clients typically
describe themselves in negative pathological ways, not considering possible
strengths and abilities. Erickson, as in the earlier story of marital impotence, sought
to positively reframe the client's self-perception. The process of assessment is non-
pathological in its orientation as we seek to identify and/or rename (i.e., create a
different story) behaviors or beliefs that are part of the client's strength. In contrast,
the Diagnostic and Statistical Manual (DSM-IV) attempts to codify observed
pathology. While DSM-IV has its contextually defined uses, an assessment based
on a developmental/interactional orientation which seeks to identify and enhance
client strengths has utility within our epistemological frame.
Present and Developmentally Oriented. What the client needs and wants to
accomplish in the present is of utmost importance in Ericksonian therapy. While this
sometimes is examined in the context of past or changing needs, the primary
attention is focused on immediate and upcoming developmental demands. For
example, Erickson (Haley, 1967) saw a young adolescent who had encopresis. The
emotional maltreatment of the child suffered by the parents in his early childhood
214 Matthews

years was obvious to Erickson. However, he made two important determinations:

(1) the parents were not emotionally available for therapy; and (2) an adolescent
with encopresis would be arrested in his development and eliminated from positive
interactions with his peers regardless of how or why such a symptom developed.
While a clear historical etiology of the problem could be offered, the present and
future developmental difficulties became paramount to Erickson. His single ses-
sion, 4-hour hypnotic treatment focused on stopping the encopresis and supporting
the client's adolescent development. Erickson reported the treatment to be success-
ful and the individual went on to develop positive peer relationships and success in
school. While a client's problem, by definition, had to have developed in the past,
how it is maintained in the present and is problematic for the future becomes the
focus of this approach.
Strategic. Finally, the therapist is active and shares responsibility for initiating
therapeutic movement and creating a context in which change can take place
(Erickson & Rossi, 1979). This is often facilitated by introducing conversational
material into the therapy session and by the use of extramural assignments. That is,
a therapist may not wait until clients spontaneously bring up material but rather may
invite or challenge clients to grow and change by creating a context in which change
can occur. Behaviorally oriented homework is important for the client to experience
thoughts, behaviors, affect, attitudes, and self-image connected to the treatment
goals (Lankton, Lankton, & Matthews, 1991; Matthews, Lankton, & Lankton,
1993). In this way, each session becomes a foundation to consolidate previous
learnings to further movement toward established goals.

ERICKSONIAN HYPNOTHERAPY
Hypnosis has traditionally been defined by most practitioners as a sleeplike state in
which individuals are thought to be more suggestible than in the normal waking
state. Research by cognitive-behavioral theorists (Barber, 1969; Kirsch, 1990;
Sarbin & Coe, 1972; Spanos & Chaves, 1989) have challenged these assumptions.
These researchers have reported that: (1) no physiological markers of the hypnotic
state have been found; (2) increase in suggestibility is small and other nonhypnotic
procedures can match or surpass hypnotic suggestive responsiveness; (3) hypnotic
phenomena can be produced in the absence of hypnosis; (4) most hypnotized
subjects describe hypnosis as a normal state rather than an altered state; and (5)
hypnotic states appear to be no different than those produced by progressive
relaxation (Kirsch, 1993).
Given this information, one might well ask what is hypnosis and why use it?
Based on the earlier epistemological discussion, I would suggest we are creating,
with the client, a particular social context (via hypnosis) that may have therapeutic
utility in constructing a new life narrative. As Kirsch (1990) indicates, hypnosis can
create a context, through the attitudes, beliefs, and positive expectancies, in which
the client's limiting cognitions, beliefs, and behaviors can change. As one might
Erickson and Constructed Reality 215

expect, for clients who are skeptical and/or fearful, hypnosis may have a negative
impact on the therapy process. However, as was presented in the discussion on
conscious/unconscious dissociation, hypnosis can allow the client the opportunity
of exhibiting behaviors and attitudes that he or she did not believe possible due to
the limitations of the conscious belief system. This notion is the essence of how
Erickson worked. He believed the therapist's job was to create the climate for
change (Lankton & Lankton, 1983; Lankton, Lankton, & Matthews, 1991; Matthews,
1985). The underpinning for this therapeutic climate is the importance of shifting
client expectancy from the negative to the positive.
Rossi (Erickson & Rossi, 1980, vol.4) indicated that Erickson represented a
paradigmatic shift from the traditional orientation in his approach to hypnosis. In
Erickson's view, hypnosis was not a process of programming the client with the
therapist's goals but rather "an inner resynthesis of the patient's behavior achieved
by the patient himself (italics added) (Erickson & Rossi, 1980, Vol. 4, p.l).
Erickson noted in 1948 that the hypnotized person remains the same person and is
not by virtue of experiencing hypnosis more suggestible, To the extent that his or
her behavior is altered in the hypnotic experience, the altered behavior derives from
the life experience of the client, not from the therapist (Erickson & Rossi, 1980, Vol.
4).
This notion of an inner resynthesis by the client provided the basis for Erickson's
use of indirection. Erickson observed that responses to direct suggestion typically
did not entail the reassociating and reorganizing of life experiences that result in
long-term change (Erickson & Rossi, 1980, vol.4). This process of reorganization
is the essence of therapeutic change as opposed to a response to a given suggestion.7
For example, in dealing with a client with chronic pain, one could give direct
suggestions for the amelioration of pain and such a suggestion may have an
immediate effect. It was Erickson's view, however, that amelioration of pain is
better produced by initiating a process of mental activity within the client by
suggesting he or she recall the feeling of numbness after a local anesthesia, or the
feeling of an arm or foot that went to sleep and then suggesting that the client can
now have that remembered feeling in the discomforted area. In this manner, the
client is given the opportunity to go through those inner processes of deconstructing,
reorganizing, and reassociating previous experiences (e.g., naturally occurring
numbness) to meet the requirements of the suggestion. Thus, the suggested
anesthesia can become a part of the client's experiential life rather than a passive
superficial response to not feeling pain (Erickson & Rossi, 1980, vol. 4). This is the
essence of developing a new narrative.
Psychotherapy and/or hypnotherapy is aprocess of identifying one's metaphors.
Deconstructing those metaphors, followed by the construction of metaphors de-
signed to have greater utility than the ones currently in use. From an Ericksonian
perspective, this process will often occur at the tacit or unconscious level. The
therapist's job is to stimulate this process, not knowing exactly what that uncon-
scious activity may be (i.e., the same story will have different meanings to different
276 Matthews

clients). Once this process has begun, the therapist guides the client toward the
desired results as defined by the therapist and client. As Erickson pointed out, how
to guide the client is the therapist's problem while the client's task is to develop,
through his or her own efforts, a new learning (i.e., create a different story) of his
or her experiential life. The development of these new learnings is done within the
client's framework, not the therapist's.

CONCLUSION
In this article, I have attempted to lay the foundation for the epistemological shift
from an objective to a constructed notion of reality that Erickson's work represents.
Historically, hypnosis has spanned three different periods of Western intellectual
development: from Anton Mesmer and the romantic period, in which the irrational
side of human development was considered, to the modernist period with its
metaphor of humans as scientific machines ultimately knowable, measurable, and
defined by external input, to our present postmodernist frame in which the notion
of an objective reality is replaced by constructed narratives derived from our daily
language within the context of culture.
The work of Milton Erickson (1901-1980) in covering 50 years of clinical
practice anticipated this epistemological shift. The essence of this approach is to
create an expectancy for change, disrupt, distract or otherwise occupy the limited
conscious mind, and thereby create a context for the client in which a change in his
or her self-narrative can occur. Within this perspective, hypnosis is used as a social
interaction constricted by the therapist and client in which different multiple
realities for the client can emerge. Hypnosis becomes a form of communication in
which clients are provided a context to develop a more useful life narrative than that
with which they entered therapy.

NOTES
' This story is reported by Jay Haley (1973) in Uncommon Therapy.
2
The essence of this discussion was the result of a 2 day seminar with Harold
Goolishian, Ph.D., of the Galveston Family Inslitute, Galveston, Texas, in October
1988.
3
This perspective in no way diminishes the value of traditional psychological
research. Such research is one particular fiction of value within a particular socially
constructed frame.
4
Erickson was fond of saying that he espoused no single theory of personality but
rather focused on the uniqueness of each client, i.e., multiple theories of personality.
This perspective of Erickson been misunderstood by many to imply that (a) he
operated in the absence of theory and therefore (b) no theory is needed but rather a
set of clever techniques. This perspective has led to a misunderstanding of Erickson
and in many instances a misapplication of his work.
Erickson and Constructed Reality 217
5
Cure implies a linear medical model notion of the passive client who receives an
intervention from the expert. As I discuss it, change is meant to imply an active
participation by the client to develop beliefs and behaviors defined within the goals
of therapy.
6
The notion of unconscious is of course a constructed fiction by the therapist.
However, it is a clear example of Erickson's use of a positive expectancy to directly
and/or indirectly suggest to the clients that their is another part of self (their
unconscious mind) that can be used to solve their dilemma. This also becomes a
therapeutic double-bind because if their unconscious has a problem solution, then
by definition their conscious mind can not yet know it. Within this frame, it is
difficult for clients to challenge the therapist.
7
It should be noted that the empirical support for the use of indirect suggestion is
mixed at best (Matthews, Lankton, & Lankton, 1993; Weekes & Lynn, 1990).
However, an indirect suggestion in a laboratory setting may have a significantly
different meaning than that offered in a clinical context. The need for a reorganizing
of life experiences presumably places a different demand on the individual than
would be expected in the laboratory setting.

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