Sanctuary for the Abused
Wednesday, September 21, 2016
The birth of Milton H. Erickson’s Confusion Technique:
Milton Erickson’s Collected Papers-Volume I-pg. 259
"One windy day as I was on my way to attend that first formal seminar on hypnosis conducted by Clark Hull in 1923 , a man came rushing around the corner of a building and bumped hard against me as I stood bracing myself against the wind. Before he could recover his poise to speak to me, I glanced elaborately at my watch and courteously, as if he had inquired the time of day, I stated “It’s exactly 10 minutes of two,” although it was actually closer to 4:00pm, and I walked on. About a half a block away I turned and saw him still looking at me, undoubtedly still puzzled and bewildered by my remark."
"I continued on my way to the laboratory and began to puzzle over the total situation and to recall various times I had made similar remarks to my classmates, and acquaintances and the resulting confusion, bewilderment, and feeling of mental eagerness on their part for some comprehensible understanding. Particularly did I recall the occasion on which my physics laboratory mate had told his friends that he intended to do the second (and interesting) part of a coming experiment. I learned of this, and when we collected our experimental material and apparatus and were dividing it up into two separate piles, I told him at the crucial moment quietly but with great intensity, “THAT SPARROW REALLY FLEW TO THE RIGHT, THEN SUDDENLY FLEW LEFT, AND THEN UP, AND I JUST DON’T KNOW WHAT HAPPENED AFTER THAT.” While he stared blankly at me, I took the equipment for the second part of the experiment and set busily to work with the equipment for the first part of the experiment. Not until the experiment was nearly completed did he break the customary silence that characterized our working together. He asked, “How come I’m doing this part? I wanted to do that part.” To this I replied simply, “It just seemed to work out naturally this way.”Confusion techniques are techniques that disrupt the regular pattern of a person’s conscious processing strategy, thereby enabling the development of hypnotic processes. In the therapeutic context, confusion techniques utilize whatever the client is doing to inhibit hypnosis or other therapeutic developments as the basis for inducing those developments. More precisely put, is that such hypnotic techniques are naturalistic communications which disrupt rigid mentally set patterns.
Confusion techniques are based on the following assumptions:
1. There are many automatic and predictable patterns in a person’s behavioral processes, such as the handshake;
2. Disruption of any of these patterns creates a state of uncertainty dominated by undifferentiated arousal (e.g. confusion);
3. Most people strongly dislike the state of uncertainty, and are hence extremely motivated to avoid them;
4. The arousal will increase unless the person can attribute it to something (“this happened because …”);
5. As uncertainty increases, so does the motivation to reduce it;
6. The person who is highly uncertain will typically accept the first viable way by which the uncertainty can be reduced (e.g. suggestions to drop into hypnosis).
In accord with the utilization of these assumptions, most confusional techniques follow the basic steps listed below:
a) Identify pattern(s) of expression - identify a regular pattern such as a handshake, or a particular idiosyncratic pattern of the individuals, such as fiddling with the hair when nervous.
b) Align with the pattern - this involves pacing the client until the appropriate context arises. The application of rapport and respect is critical in this step to prevent the client from pulling away from the hypnotherapist.
c) Introduce confusion via interrupting or overloading the pattern - interruptions should be short and quick, usually entailing a few interruption patterns, e.g. the handshake induction involves, initial fluctuation of sensations upon the hand, followed by the lifting of the wrist with the opposite hand, a ghostly wondering look in the eyes followed with an imperceptible release of the hand being shook. This, in turn, should provide a bewilderment and uncertainty to be further utilized.
d) Amplify the confusion - once uncertainty is produced in the subject, the hypnotherapist continues to act in a completely congruent and meaningful way, which amplifies the client's confusion.
e) Utilize the confusion - at this point the client is willing to accept any simple suggestion to reduce or eliminate the confusion, at which time the hypnotherapist can simply state "That's right … go deeply into trance … now … John."
Clinical Applications of Confusion Techniques:
An Ericksonian hypnotherapist uses confusion to support the person by creating an opportunity to disengage from the rigid limits of normal ways of being and experience the "Self", in more nurturing ways. Confusion techniques can liberate a person from a false and limiting identity.
The hypnotherapist must develop, maintain, and communicate a belief that the client is an intelligent, capable, and unique individual deserving the utmost respect, and that the intent of hypnotic communication is to support the person.
Confusion should usually be introduced gradually, after rapport has been established with the client, perhaps after the 2nd or 3rd sessions. The hypnotherapist should establish that his intent is to fully respect and protect the client’s needs and values while stimulating his ability and desire to develop the desired changes. The hypnotherapist should also make clear that fulfilling these intentions will require that he communicates in a variety of ways, one of them being confusion.
In some circumstances, confusion techniques should not be used. This particularly applies to those already deeply confused, such as suicidal individuals, and people in grieving. With these people, confusion is already present – the hypnotherapist only needs to utilize it.
The client’s processes should be the basis for selecting or developing confusion techniques. The general utilization principle that "whatever a person is doing is exactly that which will allow trance to develop", can help the hypnotherapist realize what type of confusion technique might work, and how and when it should be applied.
Key elements & workings of Confusion Techniques:
The various forms of confusion techniques developed are based on the assumption that, as humans, we require understanding, and somewhat of a comprehension to what we experience, otherwise we tend to shut down and go inside, in order to possibly make sense of the confusing occurrence.
There are various techniques employed to do this, such as the handshake induction, pantomime, shock, and various forms of verbal techniques.
The handshake induction employs the method of confusion via a pattern interrupt. Any specific pattern, which has been learned and requires a sequence of steps from beginning to end, if interrupted causes a momentary point of confusion. The key to its use is via the operator catching the moment, and offering a simple suggestion such as, “Now, Alice…just drop … deeply into trance”. Given such an understandable, easy point of direction, the confused individual accepts the suggestion and follows it.
When employing the confusion technique verbally, steps are taken via verbal wording to overload the subject’s mental abilities. This can be done using a play on words such as “knows, nose, nos”. Furthermore, irrelevancies and nonsequiturs can also be employed to achieve the desired results.
Considerations when providing suggestions for confusion to set in are that the operator speaks in a casual, but earnest manner conveying an intent, and expectation of understanding. A steady flow of language with only enough pauses for the subject to almost begin a reply, yet constantly interrupted with new trains of thought.
Eventually the play with words becomes confusing, distracting, and inhibiting, which causes the subject to develop a need for some form of communication which can be readily comprehended, and easily responded to.
Thus, “the Confusion Technique is a play on words or communication of some sort that introduces progressively an element of confusion into the question of what is meant, thereby leading to an inhibition of response called for but not allowed to be manifested and hence to an accumulating need to respond”. “The culmination occurs in a final suggestion permitting a ready and easy response satisfying to the subject, and validated by each subject’s own, though perhaps unrecognized on a conscious level, of experiential learnings”.
Milton’s Confusion Technique as printed in “The Collected Papers”,
Volume I pgs. 258, 259"
"It is primarily a verbal technique, although pantomime can be used for confusional purposes as well as for communication. As a verbal technique, the Confusion Technique is based upon plays upon words, an involved example of which can be readily understood by the reader but not by the listener, such as “Write right right, not wright or write.” Spoken to attentive listeners with complete earnestness, a burden of constructing a meaning is placed upon them, and before they can reject it, another statement can be made to hold their attention. This play on words can be illustrated in another fashion by the statement that a man lost his left hand in an accident and thus his right (hand) is his left. Thus two words with opposite meanings are used correctly to describe a single object, in this instance the remaining hand. Then too, use is made of tenses to keep the subject in a state of constant endeavor to sort out the intended meaning. For example one may declare so easily that "the PRESENT and the PAST can be so readily summarized by the simple statement, “That which now IS WILL soon be WAS yesterday’s FUTURE even as it WILL BE tomorrow’s WAS.” Thus are the past, the present, and the future all used in reference to the reality of “today”.The next item in the Confusion Technique is the employment of irrelevancies and non sequiturs, EACH OF WHICH TAKEN OUT OF CONTEXT appears to be a sound and sensible communication (i.e. - schizophasia or "word salad"). Taken IN CONTEXT they are confusing, distracting, and inhibiting and lead progressively to the subjects’ earnest desire for an actual need to receive some communication which, in their increasing state of frustration, they can readily comprehend and to which they can easily make a response. It is in many ways an adaptation of common everyday behavior, particularly seen in the field of humor, a form of humor this author has employed since childhood.
A primary consideration in the use of a Confusion Technique is the consistent maintenance of a general casual but definitely interested attitude and speaking in a gravely earnest, intent manner expressive of a certain, utterly complete expectation of their understanding of what is being said or done together with an extremely careful shifting of tenses employed. Also of great importance is a ready flow of language, rapid for the fast thinker, slower for the slower minded, but always being careful to give a little time for a response but never quite sufficient. Thus the subjects are led almost to begin a response, are frustrated in this by then being presented with the next idea, and the whole process is repeated with a continued development of a state of inhibition, leading to confusion and a growing need to receive a clear-cut, comprehensible communication to which they CAN MAKE a ready and full response."
Values of Confusion Techniques:
The values of the confusion technique are twofold. In experimental work it serves excellently to teach experimenter's a facility in the use of words, a mental agility in shifting their habitual patterns of thought, and allows them to make adequate allowances for the problems involved in keeping the subjects attentive and responsive. Also it allows experimenters to learn to recognize and to understand the minimal cues of behavioral changes within the subject. A final value is that long and frequent use of the confusion technique has many times effected exceedingly rapid hypnotic inductions under unfavorable conditions such as acute pain of terminal malignant disease and in persons interested but hostile, aggressive, and resistant.
The following was used by Milton Erickson on two separate accounts with different patients. Italicized words indicate tonal markings. “The Collected Papers”, Volume I pgs. 285, 286"
"You know and I know and the doctors you know know that there is one answer that you know that you don't want to know and that I know but don't want to know, that your family knows but doesn't want to know, no matter how much you want to say no, you know that the no is really a yes, and you wish it could be a good yes and so do you know that what you and your family know is yes, yet they still wish it were no. And just as you wish there were no pain, you know that there is but what you don't know is no pain is something you can know . And no matter what you knew no pain would be better than what you know and of course what you want to know is no pain and that is what you are going to know, no pain. [All of this is said slowly but with utter intensity and with seemingly total disregard of any interruption of cries of pain or admonitions of "Shut up".] Esther [John, Dick, Harry, or Evangeline, some family member or friend] knows pain and knows no pain and so do you wish to know no pain but comfort and you do know comfort and no pain and as comfort increases you know that you cannot say no to ease and comfort but you can say no pain and know no pain but you can say no pain and know no pain but know comfort and ease and it is so good to know comfort and ease and relaxation and to know it now and later and still longer and longer as more and more relaxation occurs and to know it now and later and still longer and longer as more and more and more relaxation and wonderment and surprise come to your mind as you begin to know a freedom and a comfort you have so greatly desired and as you feel it grow and grow you know, really know, that today, to-night, tomorrow, all next week and all next month, and at Esther's [John's] 16th birthday, and what a time that was, and those wonderful feelings that you had then seem almost as clear as if they were today and the memory of every good thing is a glorious thing "… (IF YOU THINK THAT WAS TOUGH, YOU SHOULD TRY RE-TYPING IT WITH ONE FINGER)One can improvise indefinitely, but the slow, impressing, utterly intense, and quietly, softly emphatic way in which these plays on words and the unobtrusive introduction of new ideas, old happy memories, feelings of comfort, ease, and relaxation as presented usually results in an arrest of the patient's attention, rigid fixation of the eyes, the development of physical immobility, even catalepsy and of an intense desire to understand what the author so gravely and so earnestly is saying to them that their attention is sooner or later captured completely. Then with equal care the operator demonstrates a complete loss of fear, concern, of worry about negative words by introducing them as if to explain but actually to make further helpful suggestions.
"And now you have forgotten something, just as we all forget many things, good and bad, especially the bad because the good are good to remember and you can remember comfort and ease and relaxation and restful sleep and now you know that you need no pain and it is good to know no pain and good to remember, always to remember, that in many places, here, there, everywhere you have been at ease and comfortable and now that you know this, you know that no pain is needed but that you do need to know all there is to know about ease and comfort and relaxation and numbness and dissociation and the redirection of thought and mental energies and to know and know fully all that will give you freedom to know your family and all that they are doing and to enjoy unimpeded the pleasures of being with them with all the comfort and pleasure that is possible for as long as possible and this is what you are going to do.""Usually the patients' attention can be captured in about five minutes, but one may have to continue for an hour or even longer. Also, and very important, one uses words that the patients understands. Both of the above patients were college graduates.
When such cases are referred to me, I make a practice of getting preliminary information of personality type, history, interests, education, and attitude, and then in longhand I write out a general outline of the order and frequency with which these special items of fact are worked into the endless flow of words delivered with such earnestness of manner.
Once the patients begin to develop a light trance, I speed the process more rapidly by jumping steps, yet retaining my right to mention pain so that patients know that I do not fear to name it and that I am utterly confident that they will lose it because of my ease and freedom in naming it, usually in a context negating pain in favor of absence of diminution or transformation of pain.
Then one should bear in mind that these patients are highly motivated, that their disinterest, antagonism, belligerence, and disbelief are actually allies in bringing about the eventful results, nor does this author ever hesitate to utilize what is offered. The angry, belligerent man can strike a blow that hurts his head and not notice it, the disbeliever closes his mind to exclude a boring dissertation, but that excludes the pain to, and from this there develops unwittingly in the patients a different state of inner orientation, highly conducive to hypnosis and receptive to any hypnotic suggestion that meets their needs; sensibly one always inserts the hypnotic suggestion that if ever the pain should come back enough to need medication, the relief from one or two tablets of aspirin will be sufficient. "And if any real emergency ever develops, a hypo will work far greater success than ever." Sometimes sterile water will suffice."