From Ferencszi to Livnay: a search for the different models which we use consciously & unconsciously in hypnotherapy

J. Shaul Livnay (Weisbrot) PhD

 Abstract

A positivistic approach developed in working with patients suffering from performance anxieties led to my examining the appropriateness of different hypnotic styles, based upon Ferencszi’s father/mother hypnotist, and subsequent research by Banyai who isolated 5 different styles in her lab. The elucidation of the styles was integrated into a two stage model of hypnotherapy: The first stage: amelioration of symptoms through the teaching of self-hypnosis. The second stage: exploration of meaning, meeting the symptom and integration. The different styles were inspected as they emerged in the different stages of treatment.
 
From the outset of my psychotherapeutic work subsequent to my training in hypnosis, I began to collect a series of patients exhibiting anxieties surrounding various areas of performance: tests, concerts, public speaking, groups etc. (Livnay, 2004). In attempting to deal with their concerns and difficulties, I found myself adjusting my usual, open & permissive style to becoming more and more directly suggestive and authoritative. As I found most of these patients to have achieved a healthy balance in their lives (except for this one specific anxiety-arousing area), I was able to exhibit a total belief in their abilities to succeed in this area. I called this a positivistic-authoritative approach, which turned out to be  successful in  a vast majority of the cases.
 
This development brought me to consider my style & specific role in different cases. As I consider myself an Integrative Therapist (Norcross, 1986), I asked myself whether there are different styles connected to different techniques and approaches which I apply? How could I conceptualize what I was doing? How applicable could this positivistic style be with other forms of anxiety, as well as other difficulties which patients presented? This paper will explore these questions and seek to find appropriate answers.
 
Contemplating my style brought me back to considering the research which I made for my Doctoral Dissertation (Parental discipline in relation to classroom behavior of kindergarten children, unpublished doctoral dissertation, the City University, New York,  1983).  The research was based upon previous research that had been done in Berkeley California as an aftermath of the influx of hippies in the area in the late 1960’s. Those who settled in Berkeley and formed families displayed a very distinctive disciplinary style which produced children who where lacking social adjustment. A local psychologist began to investigate the phenomenon and in a series of experiments (Baumrind, 1966; Baumrind & Black, 1967; Baumrind, 1971; Baumrind, 1975) delineated three specific parental disciplinary patterns which were associated with the development of competence in children:
The permissive  parents emphasize a benign acceptance of the child’s behavior, avoiding the exercise of control, giving no encouragement to obeying externally defined standards. The parent is available as a resource but will not intervene unless asked. Maximum freedom (seen as absence of restraint) is granted.
The authoritarian parents are physically punitive, demanding obedience, stressing their word without allowing verbal give & take; going by tradition and a strict moral code - an absolute standard of conduct derived from a higher authority. They are punitive when the child’s actions or beliefs conflict with the “correct” conduct.
The authoritative parents direct their children in a rational, issue-oriented manner. They encourage verbal give and take and show respect for the child, but take responsibility for decisions. Both autonomous self-will as well as disciplined conformity are valued. They will assert firm control when in conflict without over-restricting the child.
Baumrind (1980) classified her 3 types along two dimensions of responsiveness and demandingness (akin to Parsons’, 1955, of expressive-instrumental). (see table 1 below). In her followup (Baumrind, personal communication,1980) she discovered a fourth type, democratic or non-conforming, which was high on responsiveness but only moderate on demands. These families were characterized by a harmonious atmosphere wherein they developed principles for resolving differences.
 
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If we relate the parental disciplinary paradigm to the hypnotic situation, the demandingness is expressed by delineating specific tasks and expecting the patient to fulfill them, whether during the trance session, or during practice sessions between the sessions. The responsiveness is expressed by relating and encouraging the patient’s initiative, modification and translation of the therapist’s suggestions. It turns out that these very same patterns have been replicated in the laboratory by Eva Banyai and her group in Budapest (see below), in continuation of Sandor Ferencszi’s pioneering work in the beginning of the century.
 
Ferencszi (1909, 1916) distinguished between “maternal” and “paternal” hypnosis. He saw these two types of hypnosis as based on the patient’s same feelings of love or fear, the same conviction of infallibility, as those with which his parents inspired him as a child (Shor & Orne, 1965). Diamond (1987) in elaborating the interactional dimension of irrational alliance, spoke of the patient’s identifying with the therapist’s omnipotent powers, being similar to the paternal hypnosis; being a surrender to a loved & frightening adversary (Ferencszi, 1916). Ferencszi took an active role in inviting the use of imaginal processes and even  asking to “fabricate” a fantasy if they could not readily imagine one; that is to tell all that comes into their  mind without regard for objective reality. He sometimes offered fantasies which he felt patients should have been experiencing until the process took over in them. He claimed his forced fantasies to have an great value because they brought about the production or reproduction of scenes quite unexpected by either patient or analyst (Healy et al, 1930). See Livnay (1992a) for an extension of this approach.
 
Ferencszi’s active stance emerged from the discovery that the typical “anonymous” and “neutral” posture of analysts repeated elements of the parent-child relationship that had led to the patient’s illnesses. This brought him to develop a method of countertransference disclosure which eventually brought him to mutual analysis (Aron, 1996 p. 163). Ferencszi & Rank (1924) proposed that for cure to occur, a phase of experience had to precede a phase of understanding (Aron, 1996 p. 163) (see the two stage model below).
 
Eva Banyai & her colleagues (Banyai et al, 1990, Banyai, 1991, 1998, 2002, Varga, Banyai & Gosi-Gregus, 1993) developed an interactional model of hypnosis, discovering that even during a relatively brief experimental encounter between hypnotist and subject, that the hypnotists developed significant feelings and attitudes towards the subjects. They organized the latter into five articulated styles:
Physical-Organic style (maternal)  “Hypnosis is built mainly on positive emotions (on love, according to Ferencszi) between the participants. The hypnotist is very much “with” the hypnotized person. S/he wants mainly the hypnotized subject’s desires and ideas to come true, and facilitates the independent initiatives of the hypnotized person. S/he places emphasis on the current condition and wishes of the subject. The atmosphere of hypnosis is emotionally comforting".
Analytical-Cognitive style (paternal) Hypnosis is built mainly on respect of authority (on fear, according to Ferencszi). The hypnotist leads and directs the hypnotized person. S/he wants to realize mainly his/her own ideas and intentions, and slightly limits independent initiatives of the hypnotized person. S/he does not place emphasis on the current condition and wishes of the subject. The atmosphere of hypnosis is mentally stimulating.
Sibling style Hypnosis is built mainly on equality. The hypnotist almost goes together with the hypnotized person. S/he almost wishes to participate in the realization of the desires and ideas of the hypnotized subject, and accepts the independent initiatives of the hypnotized person. S/he places emphasis on togetherness. The atmosphere of hypnosis is intimate”.
Lover-like style “Hypnosis is built mainly on erotic attraction. For the hypnotist, it is mainly the feelings and emotions elicited in him/her by the hypnotized person that are important. It is almost indifferent for him/her if the hypnotized subject’s desires and ideas come true or not, or if the hypnotized person has independent initiatives. S/he places emphasis on his/her own feelings. The atmosphere of hypnosis depends on the response”.
Friend-like style “Hypnosis is built mainly on equal complementary relationship. The hypnotist accepts taking the role of the leader in the given situation. S/he helps to realize the hypnotized subject’s desires and ideas to come true, and respects his/her sovereignty. The atmosphere of hypnosis is friendly.
 
We might ponder what makes the hypnotist so susceptible to such positions. Is the style a result of the hypnotist’s personality? Or is it a response to the specific patient or subject? The concept of the Therapist Trance (see Diamond,1983,1984,1986; Erickson & Rossi, 1977; Gilligan, 1987; Livnay, 1995, 1996) emphasizes how the therapist is especially affected by the patient in a hypnotic situation. If I consider the different components of my style or demeanor with patients, I find a combination of the many styles described by Banyai & her group: empathic-supportive, authoritative, determined & coaxing, playful, humorous, teasing & flirtative. When does each component come into play? In respect to which stage in the therapeutic process does it become relevant? Let us turn to the two stage model with respect to anxiety states to seek the answers.
 
Anxiety States
 
As I reflect upon my work with patients suffering from states of anxiety, I have dealt with patients suffering from panic states. generalized anxiety, focused anxieties or phobias, and performance anxieties briefly discussed at the outset. In these various cases, I discern two distinct stages of intervention: amelioration and exploration. In pondering what model of intervention I am applying, I am reminded of Heinz Werner’s orthogenetic principle of development (Werner, 1957). He stipulates that all beings, organizations, nations etc. undergo three different stages of development:
The first stage is global, undifferentiated. Things are seen and experienced in generalities. “I am just terribly anxious”!
The second stage entails the differentiation of the whole into separate, discrete parts or categories. “I notice that whenever I am in a ..., I get terribly anxious”.
The third stage entails a re-integration of the separate parts into a complex whole. Werner emphasizes that this stage is always attained.
 
Werner’s model is especially applicable to hypnotherapy, as most often, we utilize dissociation in the beginning of our hypnotic intervention, and only later work towards integration.
 
The Amelioration stage
 
Anxiety, acute pain, debilitating symptoms bring about a regressive state wherein the patient is functioning at a primitive level
The initial stage of therapy requires a combination of authoritativeness and warm support:
 
All communication is kept to a very simple, succinct and  clear style.
The therapist is informative about anxiety, the bodily symptoms, their explanation in terms of fight/flight, etc.
The therapist must be highly supportive and understanding of the suffering  which the patient is experiencing.
The model is more of a teacher and trainer, as the focus is placed upon teaching the patient self hypnosis to deal with the various symptoms.
 
What style is being implemented at this stage? We have components of emphasizing authority in the communication style, being a teacher & trainer (Father?), as well as the need for support and warmth (Mother?). Both are contained in the authoritative stance described above. Probably, we can talk about shifts in emphasis or a sort of oscillation, where the therapist senses when to emphasize authority, and when to apply succorance.
 
A young female soldier came for treatment for an acute anxiety state whenever she would be in a car (even as a passenger), subsequent to a series of accidents both as a driver & passenger. At the outset, I informed her that following her learning self hypnosis to reduce the symptoms of her anxiety, that we would be going out into the car to help her deal in-vivo with her anxieties. She immediately vehemently protested & seemed  upset. We postponed the discussion and she made good progress until I announced that we would be spending the session “just sitting” in my car. Despite an initial protest, she cooperated. This was followed, next session, by a brief drive within city streets in the neighborhood. She then stipulated that only not on a highway! The following session, I proceeded to drive to a “highway-like” wide street, and “found myself” telling her about the strange French habit of telling drivers seeking directions “tout droite” (drive straight ahead). I repeated this message in many variations, and very quickly, she entered a deep somnambulistic trance, eyes wide open but fixed straight ahead. Upon our return, she remarked that she had been so hyper-vigilant, not thinking that she could simply just keep her eyes straight ahead. Without going into the results of the hypnotic intervention, the emphasis was upon a very active,  assertive and challenging position which I adopted to deal with and overcome the avoidance which perpetuates the symptomatic behavior. The challenging, father-like stance followed much support and warmth in accepting and teaching her to deal with the symptoms.
 
When I follow such an firm, authoritative stance, I often wonder, following strong attempts upon the part of the patient to dissuade me from my insistence upon trying themselves out in certain anxiety-evoking situations, whether I have misjudged their strengths and abilities? Am I stuck in my own trance so that I misread the cues? However, each time, I have persisted, & found my “instincts” to prove reliable. My persistence led each time to a breakthrough.
 
The Exploratory Stage
 
Once the patient achieves a moderate measure of control over the symptoms, the exploratory stage begins. It should be noted that in some cases, the patients are satisfied with the relative improvement, and choose to finish therapy at this point. However, since relative control includes episodes of regression, most patients agree to solidify their gains by completing the second stage.
 
If we look at the integrative approach, whereas the previous stage was supportive and primarily behavioral, the present stage is a combination of Hypnoanalytical (psychodynamic), Ego State, Gestalt & Psychodrama.
 
 
The stage is characterized by:
The therapist encouraging exploration of the significance and meaning of the various symptoms. 
The therapist is supportive (mother) as well as gently leading (father).
The therapist encourages meeting the “other side, the shadow, the tail”.
The stage entails integration and working through (third stage of Werner).
We begin with a discussion of my view of symptoms: they are seen as an attempt to signal to the person that his development was not adequate to meet certain challenges, so that they provide a signal that something is amiss, that something needs to be changed. In that light, I introduce various means of discovering the meaning.
 
Most patients who seek hypnosis, come with a view of the therapist expelling, removing, destroying the symptoms.  I propose an analogue (as opposed to digital)  view of modifying, altering by degrees until the signal function is reached: that level where the intensity is so low as to cease being disruptive, and yet noticeable, so that the patient still knows that there is something amiss. Now, it is possible to concentrate upon “meeting” without excess “noise”.
 
I tell the story of the knight, who on a specific hot day, was feeling very uncomfortable in his armor. He decided to get off his horse and proceeded to remove his armor and put down his weapons. Then he discerned another knight galloping towards him, weapon raised! As the 2nd knight came nearer, he was puzzled by this strange sight: a knight with his armor and weapons beside him. The first knight removed his glove and held out his hand. The 2nd knight dismantled and found himself putting down his weapon, and giving his hand. Thus was born the handshake ritual! Within the latter, we have all of the elements of a drama: can I risk letting down my defenses to find out more about the “other’s” intentions? Can I be proactive by leading with a message of peace instead of war & aggression?
 
The meeting can be carried out by varied means: 
Ideo-motoric: whether using the Pendulum, finger-signaling, or alternating hands. The patient is invited to enter the observer role, and told that I will be speaking with that side, part, voice within that is in charge of the symptomatic behavior. The patient is asked to report any relevant feelings or sensations, while refraining from consciously attempting to answer the questions. I then “speak” to that part, requesting whether it is willing to share with us (myself and the conscious mind) information about the symptomatic behavior. If there is a positive response, I go on to pose questions about the reasons for the behavior or symptom, the conditions maintaining it, including requesting sharing, bringing up to consciousness etc. This kind of discourse is very suggestive, leads to a dissociation between observing and experiencing ego, and invites a process of joining between conscious & unconscious.
Ego State (Watkins, 1992, 2002): Invitinga dialogue with the symptom. After the patient is brought into trance, I invite the ego state responsible for the symptom to come forth. A dialogue develops along the lines described above for ideo-motor signaling.
Gestalt Hot Seat (Perls, 1966; Polster & Polster, 1973): A further variation of the foregoing is to invite a dialogue with the symptom by imagining it seated in a chair opposite the patient. The latter is hypnotically induced to produce a positive hallucination of the figure, and then invited to begin a dialogue to enquire about the meaning. The patient is requested to change seats when a response is required, to enter “the symptom’s shoes” and to respond for it. To the extent that the patient enters the role & the discourse, a meaningful experience is created. Hypnosis serves as a useful enhancement to the standard Gestalt technique. The coach/director role is here dominant.
Hypno-projective: For example, using the Theatre Technique (Wolberg, 1945) to invite the patient to project onto stage the reasons behind and around the symptom, and subsequently finding new solutions to dealing with the problem.
Age regression: Regressing the patient to the age wherein the problem was created. 
 
A 60 year old woman came to deal with a driving phobia which she had been suffering for 30 years. Several sessions of hypno-therapy led to a considerable remission in the symptoms, till we went onto a highway, and she felt again overwhelmed by anxiety while in the middle lane. I told her that we had to “listen to the symptom” by turning to other methods. Previous attempts at utilizing ideo-motor questioning had failed to yield any results. She reiterated her feeling that she had built a fortress around her childhood. When she reported increasing tension in her stomach, I chose to use Watkins’ Affect Bridge (Watkins,1992), inviting her to amplify the feelings in her stomach until they bring her back to an earlier time (or 1st time) when she felt likewise. She found herself in the shower at 15, with extreme tension. She then began to talk about how her mother had warned her to beware of her father after puberty. This opened up an onrush of highly painful memories during the following sessions around a hyper-critical and rejecting mother who had great difficulty accepting her daughter’s sexuality and individuality (even as a young child). Significant oedipal issues emerged which had led to avoidance of marriage and close intimate relationships with appropriately available men. On the highway, she found herself intimidated and almost paralyzed by “wild” male drivers speeding on the highway! Working through the issues that came up enabled her to separate driving for driving sake, from the symbolic input that had loaded the driving to create and maintain the phobia.
 
 
Work with the Gong: A further means of working towards dialogue and integration is by utilizing the Gong (see Livnay, 1995b). The non-verbal mode lends itself to depth and transcending usual defenses to provide a unique means of connecting to the symptom. My role in this work is more of a coach, standing next to the patient, holding the frame, encouraging letting go & flowing with the “playing”. Inviting the patient to “speak with the symptom” through hitting the gong, to enter the anxiety provoking area and to transcend it often leads to significant breakthroughs. This serves as a sort of unique psycho-drama (Blatner, 1997), wherein the patient enters into the momentum of the striking motion, interacting with the tones & vibrations emanating, & flowing with imagining a dialogue without words.
A 37 year old woman was struggling with the aftermaths of escaping from a very abusive relationship with a man. In beginning to work with the Gong, she experienced several regressive images of a difficult relationship with a very abusive mother. When I invited her to “speak” with her mother through the Gong, she became very reluctant & asked me to do the playing. I received a strange sensation around my midsection, & shared with her a strange impulse that had come into my mind to take off my belt! She was astounded & immediately produced several painful memories of having been beaten by her mother with a belt. Following these disclosures, she was able to return to the Gong and find a release and some closure with her mother.
 
This is an example as well, of enactment, as mentioned above (Ferencszi, 1916; Livnay, 1992a), wherein the therapist allows himself to be taken into the drama, and play a part in enabling the drama to come to a resolution. The non-verbal medium provided by the Gong opens both parties to access further dimensions.
 
I have briefly described different means to bring about an integrative trend, by encouraging the patient to turn the ego-alien symptom, into an accepted, purposeful force within. One of the prime metaphors which I utilize during the integrative phase is that of the host, or of the orchestra conductor. In each case, the message is to accept all parts and sides, while making order and directing the interaction between the different sides, voices, parts, towards achieving harmony. In this phase, I act as a kind of director to the director within the patient, encouraging the ego-synthetic functioning, facilitating tolerance and furthering reorganization and enhancing of the self as a unified whole.
 
Other conditions
While this discussion has concentrated on the treatment of patients suffering from various anxieties, the model is appropriate as well for more general conditions, including pain and personality disorders. In the latter, the process is much more extended, with the first phase concentrating on the formation of the therapeutic alliance, stabilizing the relationship by enhancing object constancy, and teaching self-soothing. The second stage entails extended work with introjects, stabilization and integration. See Baker (1981) for an excellent elaboration of a hypno-developmental model, as well as Livnay (1992, 2001, 2002).
This paper has attempted to raise our consciousness & awareness as to how & what role we take in re-enacting the patient’s drama towards a more successful and conducive resolution. I contend that we pick up minimal or unconscious clues from the patient as to their needs at each stage of treatment.  The use of the therapist trance described above facilitates this sort of communication and attunement. We translate these clues into a style of interaction, which could be distinguished along the dimensions  of responsiveness & demandingness as proposed by Baumrind above. These correspond to several of the styles found by Banyai and her group.  
 
 
 
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