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American Journal of Clinical


Hypnosis
Publication details, including instructions for authors
and subscription information:
http://www.tandfonline.com/loi/ujhy20

The Clinical Importance of


Sociocognitive Models of
Hypnosis: Response Set Theory
and Milton Erickson's Strategic
Interventions
a b
Steven Jay Lynn & Steven Jay Sherman
a
State University of New York at Binghamton
b
Indiana University
Published online: 30 Jul 2013.

To cite this article: Steven Jay Lynn & Steven Jay Sherman (2000) The Clinical
Importance of Sociocognitive Models of Hypnosis: Response Set Theory and Milton
Erickson's Strategic Interventions, American Journal of Clinical Hypnosis, 42:3-4,
294-315, DOI: 10.1080/00029157.2000.10734363

To link to this article: http://dx.doi.org/10.1080/00029157.2000.10734363

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American Journal of Clini cal Hypnosis
42:3/42:4. January/April 2000 Copyright 2000 by the American Soc iety of Clinical Hypnosis

The Clinical Importance ofSociocognitive Models of


Hypnosis: Response Set Theory and Milton Erickson's
Strategic Interventions
Steven Jay Lynn
State University of New York at Binghamton
Steven Jay Sherman
Indiana University
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This article documents the contributions and clinical relevance of influential


sociocognitive models of hypnosis. We argue that an appreciation of the
influence and interplay of sociocognitive constructs, combined with a
knowledge of basic research findings , can contribute to sound clinical
practice. This article extends previous statements of response set theory
(e.g. , Kirsch & Lynn, 1998, 1999; Lynn, 1998) by further elucidating the
social and cognitive underpinnings of how response sets are established,
maintained, and strengthened. It does so by providing a scientific rationale
for Milton H. Erickson 's most prominent strategic interventions.

In a guest editorial for a special issue of this journal on the interface of research and clinical
practice, Lynn ( 1994) expressed the hope that a constructive dialogue would develop between
"clinicians" and "researchers. " He also observed that, "Perhaps some day these sharp
distinctions will dissolve, and we will all truly be partners in understanding hypnosis and
exploiting its enormous potential to help people in need" (p. 83).

In a recent guest editorial in this journal, D. Corydon Hammond (I 998) has joined this
discussion. He states that, " ... quite a few of our most productive hypnosis researchers are
failing us by spending too much of their academic careers looking at theoretical fluff rather
than evaluating weighty matters that are associated with patients who suffer." (p. 2)
Hammond further avers that, "Certain academics extensively study absorption, imaginative
involvement, sociocognitive theoretical premises, contextual factors , and relationships
between theoretical constructs instead of doing outcome studies to evaluate the value of
sophisticated, multi-component hypnosi s treatment programs. (p. 3) Finally, Hammond
challenges " ... all hypnosis researchers to see to it that a significant portion of your research
consists of outcome studies instead of largely clinically irrelevant research seeking to validate
pet theories and constructs" (p. 4 ).

Lynn ' s (1994) comments, and the special issue he edited, were intended to ease
counterproductive tensions between researchers and clinicians. Unfortunately, Hammond's
comments needlessly fan the flames of these tensions. One of our main objectives in writing
thi s article is to document the contributions and clinical relevance of a number of

Request reprints from: Steven Jay Lynn , Ph .D.


Psyc hol ogy Depa rtment
State University of New York at Binghamton
Binghamton, NY 13902

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C linical Importance of Sociocogniti ve Model s

sociocognitive models of hypnosis. Contrary to the implication of Hammond's remarks,


diverse practitioners of hypnosis, from Ericksonians to cognitive-behaviorally oriented
clinicians, can find much value in sociocognitive concepts: Far from being "theoretical
fluff," and " clinically irrelevant ," an appreciation of the influence and interplay of
sociocognitive constructs, combined with a knowledge of basic research findings, can
contribute to sound clinical practice.

We have always admired Milton H. Erickson 's approach to problems in living . However,
neither Erickson nor his followers, with the recent exception of Matthews, Conti, and Starr
( 1998), have articulated a scientific rationale for this approach. This state of affairs prompted
Hilgard (1984) to observe that the "central core" of Erickson 's varied practices is elusive. In
this article, we illustrate how soci ocognitive constructs can provide a key to understanding
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the success of Ericksonian interventions. This discussion expands upon an earlier article
(Sherman & Lynn, 1990) that might have gone unnoticed by many readers of this journal
since it was published nearly a decade ago in an early issue of the British Journal of
Experimental and Clinical Hypnosis (now Contemporary Hypnosis). Additionally, the
present article extends response set theory (e.g., Kirsch & Lynn, 1998 ; Lynn, 1988) by
elucidating social and cognitive factors that shape, maintain, and strengthen response sets.'

Documenting the Effectiveness of Hypnosis: The Sociocognitive Contribution

Hammond is by no means the first to call for clinically relevant research. Beginning more
than a decade ago, such a call was trumpeted by sociocognitive theorists in a variety of
research and clinical compendiums (e.g., Barber, 1985 ; Lynn, Kirsch, & Rhue, 1996; Lynn &
Rhue , 1991 ; Rhue, Lynn , & Kirsch, 1993; Spanos & Chaves, 1989) and was echoed by
sociocognitive theorists (i .e ., Chaves, Gfeller, Kirsch, Lynn) in the special issue (Lynn, 1994)
referred to above.

In fact, socicognitive theorists have been at the vanguard of documenting the effectiveness
of clinical hypnosis and promoting hypnosis to the scientific community. Consider the
following cases in point. Some years ago, T.X. Barber ( 1985) published a highly positive
review of the many ways hypnosis could enhance the effectiveness of diverse therapies .
More recent textbooks edited by sociocognitive theorists (Kirsch, Capafons, Cardei'ia, &
Amigo, 1999; Lynn et al., 1996; Rhue et al., 1993 ; Spanos & Chaves, 1989) include optimistic
assessments of the effectiveness of hypnosis approaches and interventions for treating a
wide range of human problems and conditions. Moreover, a recent meta-analysis by Kirsch,
Montgomery, and Saperstein ( 1995) concluded that the addition of hypnosis to cognitive-
behavioral and psychodynamic treatments substantially enhances their efficacy.

A forthcoming special issue of the International Journal of Clinical and Experimental


Hypnosis (Lynn & Kirsch, guest editors) on hypnosis and empirically validated treatments
contains an important meta-analysis by Montgomery, duHamel, and Redd (2000), which
indicates that hypnosis provided substantial pain relief for 75 % of the population , and that

'It is beyond the scope of this article to deal with issues such as the nature of the evidence that would
support sociocognitive models as opposed to other theories of hypnosis, and how different hypnosis
theories interpret research on psychophysiological alterations in hypnotic and nonhypnotic condi-
tions. Discussions pertinent to these issues can be readily found in the extant literature (e.g .. Kirsch
& Lynn , 1995, 1998a,b. 1999; Lynn & Rhue, 1991 ). However, it is worth noting here that it is easy
to falsify the soc iocognitive position . Studies that demonstrate that hypnotic responsiveness is
independent of the influence of expectancies, beliefs, attitudes, interpretations of suggestions, perfor-
mance standards, and the wording of suggestions, for example, would provide strong discomfirmation
of the sociocognitive model.

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Lynn & Sherman

hypnosis is at least as effective as an analgesic as nonhypnotic interventions, including


cognitive-behavioral treatments. The special issue also contains articles indicating that
hypnotic interventions for smoking cessation, cognitive-behavioral treatments for anxiety,
posttraumatic stress disorder, a variety of health related problems, and childhood problems
and disorders either fultill the criteria for empirically validated treatments or hold promise for
achieving that status in the future (see Lynn, Kirsch, Barabasz, Cardefia, & Patterson, in press).

Sociocognitive Theories of Hypnosis

At this point it seems useful to address the question, "What are sociocognitive theories of
hypnosis?" At the core of sociocognitive theories of hypnosis is the idea that participants'
expectancies, attitudes, and beliefs about hypnosis, as well as their interpretations of
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suggestions and aspects of the hypnotic context are crucial to understanding hypnotic
responding. However, it is possible to identify a number of distinct and nuanced
sociocognitive positions that will be summarized below.

Before we present influential sociocognitive perspectives and highlight their major


contributions to understanding hypnosis and their clinical implications, it is necessary to
counter the disturbing and misguided tendency to dismiss contemporary sociocognitive
theories as having no more to say about hypnosis than that it is mere compliance or faking.
This is important to do because if sociocognitive theories were not concerned with the
subjective dimension of human experience, they would have little relevance to the clinical
practitioner.

Spiegel 's ( 1998) recent comments reflect the mistaken opinion that social psychological or
sociocognitive theorists " .. . see hypnosis as nothing more than a minor variation on the
theme of social compliance (Coe, 1978; Sarbin & Coe, 1972). This line of thinking emphasizes
pure compliance in hypnotic behavior devoid of any perceptual alteration and suggests that
the fundamental factor involved in hypnosis is a general and widely distributed human
tendency to comply with social pressure" (p. 233).

A moment's reflection would lead one to the conclusion that all cooperative participants
comply with hypnotic instructions to the extent that they direct their attention and imaginings
to the suggested events as requested by the hypnotist. But as Council , Kirsch, and Grant
( 1996) have noted, the meaningful question is whether they also fake their responses by
acting in relation to what is suggested even though they have no accompanying experience
of the suggested events, such as hand levitation .

Of course, if hypnosis were nothing more than compliance or faking , it would be of little
interest to anyone. However, hypnosis is interesting to sociocognitive theorists precisely
because of the "believed in" subjective alterations it evokes. Indeed, sociocognitive theorists
have studied a gamut of hypnotic phenomena (e.g., suggestion-related involuntariness,
hallucinations , analgesia), which involve alterations in sensations, perceptions, and
cognitions. Beyond this, the data indicate that subjective and behavioral responses to
suggestion are highly correlated on the order of .8 to .9 (Gearan, Schoenberger & Kirsch,
1995). That is to say that high hypnotic responsiveness is ordinarily accompanied by reports
of concomitant subjective experiences.

Relative to other sociocognitive theorists, Wagstaff ( 1991, 1996) has accorded compliance
the greatest role in hypnotic responding. Yet even Wagstaff has argued that before
participants will comply with a hypnotic suggestion in the absence of a genuinely felt
subjective response, they will first attempt to "try to work out what is appropriate to the

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Clinical lmponance of Sociocognitive Model s

hypnotic role, or what is expected of them" and then "apply cognitive strategies or activities
to make the experiences veridical or 'believable"' (p. 29). Accordingly, only after these
"normal" strategies to experience the suggested event as subjectively compelling failure,
are they replaced by attempts to behaviorally comply or "sham." Relatedly, Spanos (1991)
has claimed that " ... .compliance, in and of itself, cannot account adequately for hypnotic
behavior... " (p. 336).

Clearly, an important task for future researchers is to determine when and under what
conditions participants' subjective involvement in suggestions waxes and wanes, and when
pressures to engage in compliant responding are particularly prominent. Although
compliance no doubt varies across individuals and situational contexts, all sociocognitive
theorists have acknowledged that many, if not all, cooperative participants do their best to
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experience the subjective effects of hypnotic suggestions and, for the most part, succeed in
this endeavor. Indeed, it has been social psychological researchers (see Kirsch, Silva,
Carone, Johnston, & Simon, 1989; Perugini, Kirsch, Allen, Coldwell, Meredith, Montgomery,
& Sheehan, 1998) that have shown, most conclusively, that hypnosis can not be reduced to
mere compliance or faking .

Sarbin and Coe 's theory. The sociocognitive perspective can be traced to attacks on the
concept of hypnosis as an altered state of consciousness. In 1950, Theodore Sarbin challenged
the traditional concept of hypnosis as a state (e.g., hypnotic trance, hypnotic state). Sarbin
contended that hypnosis could be conceptualized as "believed in imaginings" and developed
a " role theory" of hypnosis that relied heavily on the metaphor of role to capture parallels
between the hypnotic interaction and a theatrical performance in which both the hypnotist
and the subject enact reciprocal roles. Sarbin and his colleague, W. C. Coe, elaborated the
theory (Coe & Sarbin, 1991; Sarbin & Coe, 1972) and conducted research that highlighted
the contribution of the following variables to participants' hypnotic responsiveness:
knowledge of what is required in the hypnotic situation, self-and role-related perceptions,
expectations, imaginative skill s, and situational demand characteristics.

More recently, Coe and Sarbin ( 1991) have elaborated the constructs of self-deception,
secrets, metaphors, and narratives in an expansion of their earlier role theory. Narrative
psychology embraces the idea that human actions and self-perceptions are storied.
Accordingly, Coe and Sarbin 's narrative or dramaturgical model underlines the motivated,
active, and constructive nature of hypnotic experiences and performances.

Given the fact that participants gauge their experience of hypnosis in terms of a conglomerate
of culturally generated attitudes and beliefs about hypnosis, Coe and Sarbin, as well as
other sociocognitive theori sts and individuals from a variety of other theoretical camps,
have drawn attention to misconceptions and misinformation about hypnosis as deterrents
to complete hypnotic involvement. According to the sociocognitive perspective, educating
and preparing the patient, rather than complex inductions that require special training, are
fundamental to clinical success.

Clinicians can now rely on the following empirically derived information to educate their
patients and inform their practice:

• Hypnosis is not a dangerous procedure when practiced by qualified clinicians and


researchers (see Lynn, Martin, & Frauman, 1996).

• The ability to experience hypnotic phenomena does not indicate gullibility or weakness
(Barber, 1969).

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• Most hypnotized subjects do not describe their experience as "trance" but as focused
attention on suggested events (McConkey, 1986).

• Hypnosis depends more on the efforts and abilities of the subject than on the skill of the
hypnotist (Hilgard, 1965).

• Suggestions can be responded to with or without hypnosis, and the function of a formal
induction is primarily to increase suggestibility to a minor degree (see Barber, 1969;
Hilgard, 1965).

• A wide variety of hypnotic inductions can be effective (e.g. , inductions that emphasize
alertness can be just as effective as inductions that promote physical relaxation; Banyai,
1991).
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• Direct, traditionally worded hypnotic techniques appear to be just as effective as


permissive, open-ended, indirect suggestions (Lynn, Neufeld, & Mare, 1993).

• All of the behaviors and experiences occurring in hypnosis can also be produced by
suggestions given without the prior induction of hypnosis (reviewed in Kirsch, 1997).

• Participants retain the ability to control their behavior during hypnosis, to refuse to
respond to suggestions, and even to oppose suggestions (see Lynn, Rhue, & Weekes,
1990).

• Hypnosis does not increase the reliability of memory (Lynn, Lock, Myers, & Payne, 1997)
or foster a literal re-experiencing of childhood events (Nash, 1987).

• Spontaneous amnesia is relatively rare (Simon & Salzberg, 1985) and can be prevented
by informing patients that they will be able to remember everything they are comfortable
remembering.

According to Sarbin and Coe's perspective, by inducting the patient into the role of a
hypnotic subject by way of education and dispelling misconceptions about hypnosis, by
ensuring that the patient ' s ongoing self-narrative is consistent with the shifting requirements
of the hypnotic role and treatment goals, and by monitoring the patient's role-related
behaviors, experiences , and expectancies throughout the hypnotic proceedings, the therapist
can harness the patient's imaginative abilities and direct them toward therapeutic ends.

Theodore X. Barbers model. Theodore X. Barber was influenced by Sarbin 's theorizing and
criticized the state concept because of its logical circularity. That is, that hypnotic
responsiveness can both indicate the existence of a hypnotic state and be explained by it. In
an extensive series of studies in the 1960s (Barber, 1969; Barber & Calverley, 1964, 1969) and
early 1970s (Barber, Spanos, & Chaves, 1974), Barber and his colleagues demonstrated the
important roles played by subjects ' attitudes, expectations, and motivations in hypnotic
responding, and showed that nonhypnotized subjects exhibited increments in responsiveness
to suggestions that were as large as the increments produced by hypnotic procedures. This
research supported the idea that despite external appearances, hypnotic responses were not
particularly unusual, and therefore did not require the positing of unusual states of
consciousness. Accordingly, there is no need for clinicians to insure that their patients are
in a "trance" before meaningful therapeutic suggestions are provided.

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Clini cal Importance of Sociocogni1i ve Models

Barber ( 1985) has forcefully argued that administering suggestions in the context of hypnosis
can improve therapeutic outcomes by (I) generating positive treatment motivation and
expectancies that serve as self-fulfilling prophesies; (2) capitalizing on patients' beliefs that
therapists who use hypnosis are more highly trained, skilled, and knowledgeable ; and (3)
permitting the therapist to talk to the patient in a very personal and meaningful way that is
ordinarily not possible in a two-way conversation.

Barber ( 1985) believes that most hypnosuggestive procedures can be truthfully defined as
self-hypnosis . Advantages of defining procedures as self-hypnosis include bypassing
resistances and fears associated with being under the control of another, fear of being
unaware or unconscious, fear of revealing secrets, and fear of not coming out of "trance."
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Barber ( 1985) has also made the important point that many useful suggestions such as for
relaxation, guided imagery, and imagery rehearsal, do not require unusual hypnotic aptitude.
Rather, therapeutic suggestions can be administered to many patients, regardless of their
formal hypnotizability level, in the context of a variety of therapeutic interventions. This
observation is consistent with the fact that hypnotic responsiveness is not a very good
predictor of treatment success (Kirsch , 1994). That is , even low hypnotizable persons can
benefit from hypnotic interventions.

Additionally, it makes little difference whether suggestions or the situation itself is defined
as hypnosis, relaxation, or guided imagery. Whereas labeling the context as "hypnosis" can
improve suggestibility to a small degree, it can be counterproductive to define relaxation or
imaginative procedures as hypnosis when patients are particularly resistant or opposed to
the idea of being hypnotized.

More than any other sociocognitive theorist, Barber (Wilson & Barber, 1981, 1983) has
emphasized individual differences in fantasy proneness and imaginative ability as
determinants of suggestibility. Barber (in press) has recently forwarded the intriguing
hypothesis that individuals may have distinct styles of responding to hypnotic suggestions
such that some individuals respond primarily in terms of situational demand characteristics,
whereas perhaps a much smaller percentage of individuals become more imaginatively or
dissociatively (e.g., experience spontaneous amnesia) involved with suggestions.

Spanos's multifactorial model. Spanos and his associates (Spanos, 1986; 1991; Spanos &
Chaves, 1989) have advanced a multifactorial model of hypnotic responsiveness that
acknowledges the role of attitudes, beliefs, imaginings, attributions, and expectancies in
shaping hypnotic phenomena. Spanos ( 1991) and other sociocognitive theorists (see Kirsch,
1991; Lynn, 1991) have shown that expectancies, preconceptions about hypnosis, and demand
characteristics channel imaginings, thoughts, and feelings and largely determine whether
and to what degree participants exhibit a wide range of hypnotic phenomena including
amnesia, the '"hidden observer," and suggestion-related involuntariness. This perspective
implies that therapists can have a tremendous impact on patients by altering their construal
of hypnosis and the hypnotic situation. Accordingly, therapists can substantially affect
patients ' attributions and interpretations of the hypnotic proceedings.

According to Spanos ( 1986; see also Lynn et al., 1990), responding to suggestion is not
aimless, without purpose, or lacking in direction; instead, it is goal-directed and strategic.
Raising the hand following suggestions for the hand to lift occurs as the subject imagines
along with suggestions worded to imply that the hand will lift involuntarily (e.g., "Your hand
is getting lighter and lighter, it will rise by itself." Spanos (1971) hypothesized that participants
tend to define their overt response to suggestion as involuntary when they become absorbed

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in a pattern of imaginings termed goal-directed fantasy (GDF). GDF's are defined as "imagined
situations which, if they were to occur, would be expected to lead to the involuntary occurrence
of the motor response called for by the suggestion" (Spanos, Rivers, & Ross, 1977, p. 211 ).
For instance, persons administered a hand levitation suggestion would exhibit a GDFr (i.e.,
goal-directed fantasy report) if they report such events as imagining a helium balloon lifting
their hand, or a basketball being inflated under their hand.

Whereas studies have indicated that GDFr's are related to participants' tendency to define
their overt response to suggestion as an involuntary occurrence, GDFr's are not necessarily
correlated with objective hypnotic performance (see Lynn & Sivec, 1992 for a review) Why
is this the case? Spanos argues that certain individuals can be fully absorbed in GDFr's, yet
passively wait for a suggested event, such as the lifting of an arm in response to a hand
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levitation suggestion, to " happen." Adopting this response set virtually guarantees failure.
In contrast, participants who understand that it is important to lift their arm will succeed in
passing the suggestion. In short, how suggestions are interpreted is an influential determinant
of whether or not they are accompanied by behavioral responses to suggested events.

Research on suggestion wording implies that therapists can tailor suggestions to produce a
variety of subjective experiences consistent with treatment objectives. With respect to patients
who place a premium on control, traditional suggestions that contain GDFs may produce
discomfort associated with perceived involuntariness and feelings of loss of control. On the
other hand, when patients feel comfortable with such feelings and associate involuntariness
with a "real" hypnotic response, traditional suggestions that contain GDFs may reinforce
their conviction that they were " hypnotized." Additionally, actual hypnotic performance,
rather than merely subjective experiences, can be facilitated when patients are instructed
how to interpret different suggestions (see Wagstaff, 1996).

One of Spanos 's most important contributions has been to highlight the fact that hypnotic
responsiveness is malleable and can be substantially modified and enhanced. In fact, studies
reveal that the majority of low suggestible participants test as high hypnotizable participants
after they undergo a training program (Gorassini & Spanos, 1986) that includes the following
components: information to instigate imagination, positive attitudes and expectancies, and
motivation to respond; information designed to promote interpretation of ambiguous
suggestions in a manner consistent with successful responding; and exposure to a video-
taped model who enacts successful responses to suggestions and verbalizes imagery-based
strategies to facilitate subjective response.

Evidence secured in a number of laboratories (see Gfeller, 1993; Spanos, 1986) indicates that
treatment effects are not ephemeral; rather, they persist for an average of two and a half
years after training; they generalize to novel, demanding test suggestions; they result in
responsivity that is indistinguishable from untrained high hypnotizable participants; and
treatment-related gains are maintained even when tested in an entirely novel test context in
which participants fail to connect their earlier training and subsequent hypnotizability testing.
Research that addressed this latter issue (Zivney, Lynn eta!., 1993) provides strong evidence
that large magnitude treatment gains can not be attributable to simple compliance effects.

Combined, these findings challenge the received wisdom that hypnotic responsivity is a
trait-like, stable attribute that can be modified only within narrow limits. Whereas hypnotic
responsiveness appears to be trait-like in that test scores are reasonably consistent across
repeated testing sessions, Spanos ( 1991) maintains that such stability is to be expected in

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Clinical Importance of Sociocognitive Models

the absence of any changes in the influential determinants of hypnotizability that are explicitly
modified in training programs (e.g., expectancies, imaginings , and interpretations of
suggestions). When changes in such moderator variables are influenced by training,
hypnotizability can be substantially increased. Importantly, Spanos 's research makes it plain
that clinicians can do a lot to insure that their patients' hypnotic responsivity is optimized
(see also Gfeller, 1993).

Along these lines, Gfeller ( 1993) has written perceptively on the topic of how suggestibility
modification can be used in clinical situations to enhance responsiveness to treatment
interventions. And Chaves ( 1993) has provided instructive examples of how therapists can
treat pain patients with a variety of interventions that modify the patient's cognitive strategies
and interpretations of the experience of pain.
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Kirsch s response expectancy theory. Virtually all schools of psychotherapy acknowledge


the importance of bolstering positive expectancies to maximize treatment gains and minimize
noncompliance (see Kirsch, 1991; Lynn & Garske, 1985), so it is no wonder that Kirsch has
focused his research program on expectancies. Kirsch ( 1994) maintains that, like placebos,
hypnosis produces therapeutic effects by changing the patient's expectancies. But unlike
placebos , hypnosis does not require deception in order to be effective. Rather than avoid
expectancy effects, Kirsch has made the compelling argument that clinicians should maximize
them by way of techniques such as hypnosis, which many people expect will be effective in
conquering vexing habits and in ameliorating emotional suffering.

Kirsch's response expectancy theory (see Kirsch, 1985, 1991, 1994) is an extension of
Rotter 's social learning theory, and is based on the idea that expectancies can generate
nonvolitional responses. Kirsch 's research has shown that a wide variety of hypnotic
responses covary with people ' s beliefs and expectancies about their occurrence. In fact,
expectancy, along with waking suggestibility (Braffman & Kirsch, 1998), is one of the few
stable correlates of hypnotic suggestibility (Kirsch & Lynn, 1995). Interestingly, expectancy
remains a significant predictor of hypnotic response even with waking suggestibility
controlled (Braffman & Kirsch, 1998; Kirsch et al., 1995). In short, hypnotic responding is
regarded as nonhypnotic responding with enhancements due to increased expectancy and
motivation .

The influence of expectancies can be quite subtle. Council, Kirsch, and Hafner ( 1986)
hypothesized that expectancies moderate the modest relation between hypnotizability and
personality traits such as absorption and dissociation . The researchers argued that this
relation may be an artifact of the way these traits are measured, insofar as they have routinely
been jointly administered in a hypnosis test context. This shared context of measurement
was thought to establish a subtle expectation that the measures and abilities were related.
When Council et al. measured hypnotizability and absorption in separate contexts so that
subjects did not associate or connect the two measuring instruments, no correlation between
the measures was apparent.

The role of context effects has not gone unchallenged and has generated considerable
controversy (e.g., Nadon, Hoyt, Register, & Kihlstrom, 1991 ). However, a recent meta-analysis
(Council, Kirsch , & Grant, 1996) of 12 studies with almost 4000 participants yielded two
conclusions that seem to place the research on context effects in perspective. First, about
75 % of the variance in same-context correlations "appeared to be a context mediated artifact"
(p. 56). And second, whereas absorption and subjective and behavioral indices of

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Lynn & Sherman

hypnotizability were related even when measured in separate contexts, the effect was found
to be " ... even smaller than the context effect and accounts for only about 1 percent of the
variance" (p. 56).

The operation of expectancy effects is evident in the observations that a.) similar context-
dependency has been demonstrated for a variety of measures of dissociation (see Council
et al., 1996 for a review of the "context effects" literature), b.) imagery effects are relatively
small in relation to expectancy effects, and c.) the effects of imaginative strategies are easily
overridden by expectancy information (Council et al., 1996). Hence, expectancy may be a
more influential determinant or moderator of hypnotizability than a number of other variables
long thought to be at the core of hypnotic responsiveness . The contextual dependency of
measures of absorption and dissociation indicates that there is no inherent relation between
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dissociation and hypnotizability, thereby challenging one of the central tenets of dissociation
theories of hypnosis (see Kirsch & Lynn , 1998a,b). Kirsch and Council's research on context
effects alerts clinicians to the possible influence of subtle expectancy effects.

Although imaginings may not directly cause hypnotic actions, patterns of imaginative activity
may, nevertheless, increase the distinctiveness and life-like quality of suggested events and
be quite useful in clinical situations that involve guided imagery and imaginative rehearsal.
In these situations, therapists can combine instructions to use imagery with expectancy
information (e.g., " when you imagine, your imagery will help your hand to rise") and imagery
strategies (e.g., GDF's: " the balloons blowing in the air will lift that hand of yours") to create
a variety of useful imagery-based interventions catalogued by Lynn et al. ( 1996).

The idea that expectancy effects are influential determinants of treatment outcome has a
number of other important implications. First, Kirsch ( 1994) suggests that it is important to
present a convincing rationale for the use of hypnosis that is consistent with the patient 's
wishes and worldview. If the patient rejects the rationale for the use of hypnosis, the label
" hypnosis" can be repl aced with "relaxation ," "imagery," or another term more congenial to
the patient.

Second, Kirsch (1994) believes it is important to debunk the "altered state myth" because
"decades of research have failed to confirm the altered state hypothesis." (p. 10 I) Also,
certain people are afraid of the idea of gong into a " trance" and people who believe that
hypnosis is an altered state are less likely to experience its effects (McConkey, 1986).

Third, it is important to monitor and modify changing expectancies throughout the course of
therapy. Clinicians who use hypnosis have long been aware of the importance of imparting
the belief that response to suggestion is positive. Even before hypnosi s "officially begins,"
therapists can administer relatively easy suggestions to secure an informal assessment of
minimal suggestibility and to illustrate the power of suggestion. Kirsch has recommended
the Chevreul-pendulum illusion (see Kirsch, 1994 for a detailed descrption of the procedure)
for this purpose. As hypnosis progresses, it is helpful to reinterpret failures to respond to
hypnotic suggestions as successes to maintain a positive evaluation of performance.

Kirsch ( 1994) has made the following recommendations for bolstering expectancies about
positive therapeutic outcomes. "Be permissive. Present and respect choices as therapeutic
double binds, so that either choice promotes improvement. Prevent failure by beginning
with easy tasks that the patient is almost certain to accomplish. Proceed gradually to more
and more difficult tasks. Define tasks so that failure is impossible. Structure expectations so
that even small improvements are seen as significant beginnings. Be alert to random

30 2
Clinical lmponance of Sociocogniti ve Models

fluctuations and capitalize on those that occur in a desired direction. Prepare patients for
setbacks by labeling them in advance as inevitable, temporary, and useful learning
opportunities" (p. I 04 ).

Lynn et al. s integrative model. Lynn 's model is integrative in the sense that it integrates
situational, intrapersonal, and interpersonal variables in accounting for individual differences
in hypnotic responses, and in the sense that hypnotized individuals creatively seek and
integrate information from an array of sources in a goal-directed manner.

Research in Lynn's laboratory has documented the importance of affective, relational, and
rapport factors (Frauman & Lynn, 1985; Lynn, Weekes, Brentar, Neufeld, Zivney, & Weiss,
1991 ); response sets and expectancies (Lynn, Nash, Rhue, Frauman, & Sweeney, 1984); the
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performance standards by which participants judge their success or failure (Lynn, Green, &
Jacquith, 1999); how hypnotic communications, sensations, and actions are processed and
interpreted (Lynn, Snodgrass, Rhue, Nash, & Frauman, 1987); the dynamic and at times
unconscious motives and fantasies that come into play during hypnosis (Frauman, Lynn,
Hardaway, & Molteni, 1984); and the features of the hypnotic context that discourage
awareness and analysis of the personal and situational factors that influence hypnotic
responses (see Lynn et al., 1990).

Relative to other models reviewed so far, Lynn and his colleagues place more emphasis on
relational factors and unconscious determinants of hypnotic responsiveness and less
emphasis on concepts such as self-deception (Coe and Sarbin), fantasy (Barber), compliance
and conformity (Spanos), waking suggestibility (Kirsch), and self-presentation , role
enactment, and role playing (Coe and Sarbin, Spanos). The integrative model's central
focus is on the general human capacity for creating psychological situations that engender
desired experiences.

The integrative model gives credence to the idea that individual differences play an important
role in hypnotic responding. Yet it also acknowledges that no single hypnotic capacity or
ability (e.g., relaxation, absorption, dissociation) can adequately capture the multilayered
richness, diversity, and complexity of hypnotic performance. Because hypnotic activity is
multidetermined and multifactorial, it requires a variety of abilities or personal qualities.

The ability to relinquish a modicum of perceived control and participate fully in a cooperative
relationship in which the role of the "good hypnotic subject" is enacted is undoubtedly
important. Important individual differences may exist in participant expectations about
hypnosis and the ability to detect, interpret, and respond appropriately to subtle messages
and cues inherent in verbal and nonverbal communcations and interpersonal behaviors,
across a range of hypnotic and nonhypnotic situations. Individuals may also differ in their
ability to translate suggestions into sensations (e.g. , feeling wet while imagining oneself
swimming), which may vary, to some extent, independent of imagery vividness or fantasy
proneness in general. Whereas participants may differ in their attentional, fantasy, and
imaginative abilities, only a minimal degree of such abilities may be necessary for many
individuals to adopt the definition of the situation called for by many suggestions (Lynn &
Rhue, 1988).

To optimize responsiveness in clinical situations and to tailor the procedures to the unique
characteristics of the individual, the integrative model implies that it is essential for the
therapist to a.) develop a positive rapport and therapeutic alliance with the patient that
promotes the free-flowing quality of hypnotic experience; b.) understand the patient's motives
and agenda (i.e., constellation of plans, intentions, wishes, and expectancies) in relation to

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experiencing hypnosis; c.) identify the personal connotations that hypnosis has for each
patient, including their conflict and ambivalence about experiencing hypnosi s; d.) assess
the individual 's stream of awareness and internal dialogue during hypnosis ; e.) modify
suggestions and hypnotic communications so as to minimize resistance and increase a
sense of percei ved control when it is lacking; f.) encourage patients to adopt lenient or
liberal criteria for passing suggestions (e.g. , " You don't have to imagine what I suggest as
being real , even a faint image is fine"); and g.) encourage involvement in suggestions, the
use of imagination , and attention to subtle alterations in experiences and responses.

Kirsch and Lynn :1· theory of response sets. The theory of response sets (Kirsch & Lynn,
1997, 1998, 1999; Lynn , 1997) is an extension of Kirsch 's theory in its emphasis on expectancies
and response sets, and an extension of Lynn 's integrative model in its emphasis on attributions
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and unconscious determinants of behaviors. Response set theory centers on the observation
that much of human activity seems to be unplanned and automatic. We do not consciously
plan or think of our finger movements while typing ; of the formation of letters while writing ;
of biting , chewing, or using utensils while eating; of turning pages while reading; nor of the
all the mindless, habitual, reactive responses we emit (i.e. , scratching an itch , biting a nail,
adjusting a tie, twiddling a thumb, doodling , etc.; Kirsch & Lynn, 1998).

Response set theory (Kirsch & Lynn, 1997, 1998b) makes the radical proposal that all actions,
mundane or novel , planned or unplanned, hypnotic or otherwise, are at the moment of
activation initiated automatically, rather than by a conscious intention. Actions are prepared
for automatic activation by response sets that include schemas (i.e., knowledge structures)
or scripts for behaviors, plans, intentions , and expectancies.

Expectancies and intentions are temporary states of readiness to respond in particular ways
to particular stimuli (e.g., hypnotic suggestions) , under particular conditions. They differ
only in the attribution the participant makes about the volitional character of the anticipated
act (Kirsch , 1985, 1990). That is, we intend to perform voluntary behaviors such as stopping
at a stop sign . In contrast, we expect to emit automatic behaviors such as crying at a
wedding , or more relevant to our present di scussion, responding to a hypnotic suggestion.
To be more specific, response expectancies are anticipations of automatic subjective and
behavioral responses to particular situational cues , and they elicit automatic responses in
the form of self-fulfilling prophecies.

Kirsch and Lynn contend that, although hypnotic responses may be triggered automatically,
suggestion alone is not sufficient to trigger them. Instead, suggested physical movements
are preceded by altered subjective experiences (Lynn, 1997; Silva & Kirsch, 1992). The
response expectancy for arm levitation, for example, is that the arm will rise by itself. Yet a
sufficiently convincing experience of lightness must be perceived for upward movements to
be triggered. Once again, contrary to Spiegel 's ( 1998) contention, subjective experiences are
accorded an important place in a sociocognitive theory of hypnosis.

Because intended as well as unintended behaviors are initiated automatically, it is not the
experienced automaticity of ideomotor responses that is an illusion, but rather the experience
of volition that is claimed to characterize everyday behavior (Kirsch & Lynn, 1999). Kirsch
and Lynn ( 1997) have proposed that the feeling of will is actually a judgment involving the
attribution of a behavior to one's own agency. The interpretation that an act is voluntary is
made on the basis of such factors as culturally transmitted beliefs about the situation in
which the behavior is occurring and the consistency of the behavior with one's goal s,
motives, and intentions (Lynn et al., 1990).

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Clinical Importance of Sociocogniti ve Model s

Erickson's Strategic Approach: A Sociocognitive Analysis

In the remainder of this paper, we expand on previous statements of response set theory by
further elucidating the social and cognitive underpinnings of how response sets can be
established, maintained, and strengthened. We do this in the context of explaining how
Milton Erickson's strategic interventions illustrate how expectancies (see Matthews et al.,
1998) and a variety of response sets can be manipulated to produce constructive changes
by mechanisms that operate outside the patient's field of awareness. The raw materials of
any response set are existing patterns of mental associations, schemas, and scripts, as well
as conditioned and automatized reactions to stimuli. Under ordinary circumstances, these
mental contents and reaction tendencies are subject to little or no conscious introspection.
Accordingly, it is not surprising that the influence of many psychotherapeutic interventions
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operates largely outside the patient's field of awareness.

Erickson was well aware of the ubiquity of automatic experiences and the power of suggestions
to shape response sets and experiences. As evidence, consider the following statements by
Erickson, Rossi, and Rossi ( 1976): "Most people do not know that most mental processes
are autonomous ... The autonomous flow of undirected experience is a simple way of defining
trance." (p. 23). Hypnotic suggestion comes into play when the therapist 's directives have
a significant influence on facilitating the expression of that autonomous flow in one direction
or another." (p. 23) Finally, "The most effective aspect of any suggestion is that which stirs
the listener 's own associations and mental processes into automatic action."

Erickson 's appreciation of the crucial role of response sets is further revealed by his (Erickson
et al., 1976) observation that, "Much initial effort in every trance induction is to evoke a set
or framework of associations that will facilitate the work that is to be accomplished" (p . 58).
In fact, the authors define the "therapeutic aspect of trance" as occurring when "the limitations
of one's usual conscious sets and belief systems are temporarily altered so that one can be
receptive to an experience of other patterns of association and modes of mental
functioning .. .that are usually experienced as involuntary by the patient" (p. 20). All of these
comments concur with the general thrust of response set theory, with one exception: the
concept of "trance" seems to add nothing in the way of explicating the operation of response
sets, the ubiquity of autonomous mental processes in everyday life, and the experience of
involuntariness that Erickson and his associates so nicely describe.

Erickson devised creative and ingenious therapeutic techniques that involved manipulating
response sets and exploiting social and cognitive mechanisms of behavior change to the
therapist's, and ultimately the patient 's, advantage. A number of his most prominent
techniques and their rationale will be presented in the next section. From the discussion that
follows , it will be evident that many of Erickson 's assumptions are entirely consistent with
sociocognitive principles and response set theory.

/.Priming. Priming refers to the activation or change in accessibility of a concept by an


earlier presentation of the same or a closely related concept (see Reason, 1992). Erickson
primed his patients by introducing ideas and examples early in a therapy session so that
patients would think in certain ways later in the session or after the session. For example,
Haley (1973) reports Erickson 's conversations with Joe, a terminally ill florist. Erickson
introduced concepts relevant to plants and gardening and used concepts and ideas that Joe
might later employ in thinking about his own life and situation in terms of growth, comfort,
and beauty.

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Priming effects can be subtle; even subliminally presented stimuli can affect intrepretations
of events (see Bargh, 1994). Priming effects can also extend to behaviors. Wilson and Capitman
( 1982) primed participants with a "boy meets girl " scenario by a radio broadcast while they
were waiting for the experiment. The subtle priming had a major impact on subjects' behavior
toward a member of the opposite sex (communication , seating distance) during the
subsequent experiment. By talking to patients prior to hypnosis about various "nonhypnotic"
relaxing experiences they have enjoyed in the past such as listening to soothing music or
watching waves on a beach, and by asking patients questions about what they would like to
experience during the upcoming hypnosis session and gaining input from patients about
helpful suggestion-related scenarios, therapists can prime subsequent " hypnotic" responses.

2. Scripts. Although priming is a convenient method for demonstrating automatic effects on


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behavior, they can also be demonstrated simply by cuing response sets that have been
transmitted culturally in the form of implicit knowledge of social roles or scripts. By the age
of2, children acquire a knowledge base comprised of information about people and objects.
Knowledge of events expands and solidifies this base into adulthood, as the individual
forms generalized event representations or scripts (Nelson, 1986) about behavioral sequences
ranging from baking cookies to ordering food in a restaurant. Once immersed in a script, an
individual tends to get carried along with the behaviors in a mindless, automatic way. If a
person can be engaged in a script, the rest of the sequence will run off automatically, and
substantial behavioral control can be achieved (Sherman & Lynn, 1990).

In a striking demonstration of this technique, Langer, Blank, and Chanowitz (1978) investigated
an experimental confederate's ability to break into a long line at a Xerox machine. When
participants were simply asked if they could go to the front of the line, there was only 60%
compliance. When a valid reason (they had an important meeting and were in a rush) was
added, the compliance rate increased to 94%. However, when the confederate asked to break
into the line and added an uninformative reason ("because I have to make some copies"), the
compliance rate was 93 %. The presence of a request plus a reason seems to automatically
trigger a compliance response, the endpoint of the script.

Erickson found this technique to be useful in engendering a " Yea saying" response pattern.
He would start with questions with an obvious "yes" answer; to establish a pattern or
response set, he would keep asking such questions. Patients would apparently agree to
things that they would not have agreed to in the absence of the response set. Erickson
would induce behaviors and thoughts by subtly establishing the initial part of a sequence,
knowing that the patient would complete it. In one case, Erickson wanted the patient to think
about being warm-hearted and kind. By referring to her "cold hands," he knew that the
entire response sequence would be established.

3. Altering accessibility. Response sets can be established and reinforced by altering the
accessibility of facts or events in memory. Indeed, priming works by way of this process.
Asking people to think about possible situations or to explain hypothetical outcomes is an
effective means of altering the accessibility of facts in memory. This can increase the salience
of particular outcome expectations and bring to mind concepts and ideas consistent with
positive outcomes and inconsistent with negative outcomes. When making subsequent
judgments or decisions, these ideas will then be most accessible and will serve as a basis for
action (Sherman, Skov, Hervitz, & Stock, 1981 ). For example, imagining negative outcomes
of smoking and overeating and positive outcomes of not doing so can make it easier to resist
those urges.

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Clinical Importance of Sociocogniti vc Model s

In his therapy, Erickson used imagination and explanation of possible circumstances. Erickson
would ask patients to respond to questions such as, "If you weren't so tolerant, what would
you and your spouse disagree about?" This is precisely the kind of hypothetical thinking
that engages the processes discussed above. In addition, Erickson used anecdotes and
metaphors to activate concepts and ideas consistent with therapeutic goals.

Solution focused therapists make use of similar strategies (de Shazer, 1985; Fish, 1996).
Rather than stressing problems and their causes, these therapists direct the patient's attention
to exceptions to the problem, thereby priming adaptive thoughts and behaviors. Posing
questions to patients such as, "How would your life change if you did X?" or "What would
have to change in your life in order for you to relinquish your fear of public speaking?" might
serve a similar function.
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4. The utilization approach. Contrary to more standardized or formal approaches to clinical


hypnosis, Erickson 's "utilization" approach (Erickson , 1959; Haley, 1973) involves the
observation and facilitation of patients ' thoughts, feelings , and behaviors in response to
therapeutic communications. Indeed, one of the keys of the Ericksonian approach is to
judge whatever behaviors the patient emits as emblematic of cooperation and involvement
with the hypnotic proceedings, thereby reinforcing response expectancies of a successful
outcome.

Erickson usually took what the patient said or did and built on it. He often tied suggestions
to naturally or frequently occurring responses, or, more broadly, to whatever response the
patient made (Erickson & Rossi, 1976). Certain naturally occurring responses, such as
lowering of an outstretched arm , provide immediate positive proprioceptive feedback . On
the other hand, it is sometimes necessary to reinterpret events that do not provide positive
feedback . For example, a yawn that occurs prior to the induction of hypnosis, and that might
ordinarily be interpreted as a sign of boredom or disengagement from therapy, could be
interpreted as a signal that the person is ready to "enter hypnosis" and tied to a suggestion
to that effect.

As implied by these examples, Erickson's approach involves considerable reframing of


behaviors as consistent with treatment objectives. Indeed, Erickson used reframing to turn
the patients' deficits into assets. Impotence or premature ejaculation could be seen as an
expression of great love for the partner rather than as a serious sexual problem. An inability
to work or to travel could be seen as an opportunity to enjoy one 's life at home .

Reframing is important because behaviors will not unfold in a seamless way when they are
interrupted by feedback or information that implies that a particular thought or action is "off
target" or inconsistent with treatment goals. When this occurs, it can dampen response
expectancies and engender negative response sets that activate thoughts and behaviors
that are inconsistent with treatment objectives. Reframing is a valuable technique insofar as
objective facts are often unchangeable, but the framing of facts is subject to alteration
(Sherif & Hovland, 1961; Sherman & Lynn, 1990).

5. Increasing cooperation and minimizing resistance. It may be as important to remove


impediments to the automatic activation of behaviors and their execution as it is to create
facilitative conditions for the expression of desired behaviors. In certain patients, change
efforts can activate motivations for mastery and control and lead to the arousal of reactance-
the feeling that is experienced whenever personal freedom or control are threatened (Brehm,
1966). People respond to threats to their freedom and control by attempting to reestablish the
threatened behavior.

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Erickson realized that direct suggestions or injunctions to relinquish , suppress, or control


long-standing symptoms are often doomed to failure. This line of thought was recently
advanced by Hayes and Gifford ( 1997), who argued that poorer clinical outcomes eventuate
when people frequently use "coping strategies aimed at avoiding or suppressing negative
emotions or thoughts" (p. 170). Rather than giving suggestions for symptom removal,
Erickson's preferred approach was to use subtle paradoxical, metaphorical, illogical, or indirect
(e.g. , truisms, suggestions that cover all possible alternatives, binds, and storytelling)
communications.

Erickson rarely questioned or refuted the patient's reality. This created the impression that it
was the patient who directed the interaction. The classic example is the patient who claimed
to be Jesus Christ. Erickson simply accepted this and communicated to the patient the
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assumption that he must know a lot about carpentry. How could the patient deny it? Soon
Erickson had the patient engaged in productive woodworking.

As this example implies, Erickson often avoided telling patients how to think about events:
Direct interpretation and confrontation can provoke resistance. Instead, Erickson would
allow patients to interpret and perceive things "on their own. " He would simply set the stage
(by techniques such as priming) to increase the likelihood that patients would make
attributions and interpretations consistent with treatment goals.

Another tactic that Erickson used to counter the patient's self-defeating strategy of blocking
or preventing therapeutic change was to prescribe the symptom. That is, the person is asked
to intentionally produce the unwanted feeling, thought, or behavior. In this way, resistance
facilitates a therapeutic response.

Research has affirmed some but not all of Erickson's ideas regarding the value of using
indirect procedures with reactant subjects. In fact, one study (Lynn, Weekes, Snodgrass,
Abrams, Weiss, & Rhue, 1986) revealed that more than a quarter of low hypnotizable
participants are not merely passive responders: To maintain their sense of freedom and
control , they actively resist and even oppose the hypnotist. However, when these low
hypnotizable individuals were given paradoxical instructions that gave them permission to
do the opposite of whatever the hypnotist suggested, they were more likely to respond to
suggestions when the hypnotist gave them explicit instructions to not move in response to
a series of suggestions he delivered. Participants who received these paradoxical instructions
moved in response to more suggestions than did a group of low hypnotizables who received
no special (paradoxical) communications about how to respond. Indeed, Shoham-Salomon
and Rosenthal's (1987) review reinforces the conclusion that paradoxical interventions are
particularly effective with resistant patients.

The superiority of indirect suggestions has not been established. Several studies (Angelos,
1978; Fricton & Roth, 1985) suggest that low hypnotizables respond more completely to
indirect suggestions, whereas high hypnotizables respond more favorably to traditional
suggestions. However, the overriding conclusion from the literature (Lynn et al., 1993) on
direct versus indirect suggestion is that the "directness" of suggestions has little bearing
on behavioral response. Expectancies and perceptions of the therapists' intervention are
probably more important than the communication's "directness" or " indirectness." Much
empirical work needs to be done with the full range of creative suggestions that Erickson
used in treatment before more definitive statements can be made about the diverse
suggestions that typify Erickson's "indirect" approach.

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Clinical Importance of Sociocogniti ve Models

6. Exploiting reactance. Erickson did more than devise techniques to undercut resistance;
he exploited the patient's reactance. On occasion, early in therapy sessions, during the
induction of hypnosis, he would ask patients for a response that they failed to give . Having
expressed their freedom, they were more likely to comply with requests that were far more
important to Erickson.

It follows from reactance theory that, when positive behaviors are threatened (behaviors
that the therapist wants to see) , they will be more likely to occur. The technique of symptom
prescription is based on this principle. For instance, when a patient suffering from mild
depression is instructed to be extremely depressed, reactance can be resolved by failing to
experience depression.
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In a similar way, Erickson instructed patients that they would have a positive experience on
Monday or Thursday, but not on Wednesday. Some patients would return the next week and
report that they had the positive experience, but they experienced it on Wednesday. Of course,
it was irrelevant to Erickson when the positive experience occurred, but his technique allowed
patients to achieve a sense of control. To teach patients that they could control their symptoms,
Erickson would arrange for patients to have different symptoms than usual or to exhibit them
in a new place or at a new time. Likewise, Erickson would present the patient with a choice of
two or more alternatives (e.g., they could take one or two or three deep breaths), any of which
would be acceptable to Erickson. He assumed that the act of choosing a particular alternative
would fortify commitment to it (Sherman & Lynn, 1990).

7. Effort just(fication. In addition to establishing therapeutic response sets, it is important


to strengthen and maintain them. Cognitive dissonance theory holds that the harder people
work at things, the more they like them and the more committed they are to them . This
principle also applies to the process of psychotherapy, as demonstrated by Axsom and
Cooper (1985) . They compared two forms of "effort therapy" for overweight subjects. These
bogus therapies were based on the expenditure of effort in tasks unrelated to weight loss.
One therapy involved high effort, whereas the other therapy involved low effort. Differences
in weight loss were evident for as long as one year after therapy, with high effort subjects
losing significantly more weight.

The role of effort was not lost on Erickson. He assigned homework to patients that could
require a great deal of effort to complete: climbing Squaw Peak, carrying a heavy rock for a
week, looking up many articles in the library. Expending such effort can presumably enhance
commitment to therapeutic goals, independent of other benefits derived from the homework
(Sherman & Lynn, 1990).

Concluding Remarks

Far from being "theoretical fluff," constructs derived from social and cognitive psychology
can provide a foundation for understanding a wide variety of therapeutic techniques, and
for generating creative psychotherapeutic interventions such as those pioneered by Milton
Erickson. To be sure, Erickson fully appreciated the importance of establishing rapport with
patients; inculcating positive beliefs, attitudes , and expectancies; the need to tailor
suggestions to the unique needs and understandings of the patient; and the importance of
establishing lenient performance standards and fail-safe procedures that minimized critical
evaluation of suggested actions. Erickson ' s ingenious methods reflected an acute awareness
of the importance of creating, maintaining, and strengthening response sets that trigger a
wide variety of behaviors, thoughts, and actions consistent with therapeutic objectives.

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Whereas response set theory, and sociocognitive constructs more generally, can go a long
way toward demystifying Erickson ian interventions, they can also foster an appreciation for
powerful mechanisms of behavior change that transcend any one particular therapeutic
approach. Indeed, sociocognitive models provide a strong theoretical rationale for the
clinical application of hypnosis . Yet they also have inspired an abundance of research that
has provided an empirical base for many hypnosis practices currently in vogue. We are hard
pressed to think of another theoretical approach that has done so. Whereas sociocognitive
theorists diverge from one another in terms of the constructs they emphasize, all would
probably be united in the belief that therapy informed by scientific principles can be more
clinically meaningful than the willy-nilly application of clinical techniques deprived of the
guiding light of theory and the grounding of science.
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