Hypnotic Ego-Strengthening Procedure

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The Hypnotic Ego-Strengthening Procedure, incorporating its constituent, influential hypnotherapeutic monologue — delivering an incremental sequence of suggestions for within-hypnotic influence and suggestions for post-hypnotic influence "designed to remove tension, anxiety and apprehension, and to gradually restore the patient's confidence in himself and his ability to cope with his problems"[1] — was developed and promoted by the British consultant psychiatrist, John Heywood Hartland (1901–1977) in the 1960s.

Originally created to (pre-therapeutically) strengthen his patients' inner resources[2] — "analogous to the medical setting in which a patient is first strengthened by proper nutrition, general rest, and weight gain before a radical form of surgery is performed" (Torem, 1990, p. 110) — specifically to enhance the therapeutic efficacy of his (subsequent) symptom-removal hypnotherapy, Hartland later discovered that his "ego-strengthening procedure" could successfully address a wide range of circumstances, on its own, as the sole form of therapy.[3]

Hartland's 1965 article, "The Value of "Ego-Strengthening" Procedures Prior to Direct Symptom-Removal under Hypnosis" was significant for positioning the concept of "ego-strengthening";[4] and "ever since then, the concept could be unequivocally named, identified, investigated, productively discussed, and generally understood by all concerned".[5] The article was also significant for introducing the convention of ". . ." to indicate pauses in the operator's delivery.

"Ego-strengthening suggestions are designed to increase the patient’s ability to cope with his difficulties or to encourage him to stand on his own feet. There are three kinds of ego-strengthening suggestions: (a) general ego-strengthening suggestions, (b) specific ego-strengthening suggestions to facilitate the discovery and enhancement of the patient’s inner coping strategies, and (c) specific suggestions to foster the patient’s sense of self-efficacy. ..."
"Ego-strengthening suggestions, while seemingly simplistic, are quite valuable. Hartland and many others believe that in certain instances ego-strengthening suggestions alone can bring about a successful treatment outcome without [any need to resort to either] symptomatic or dynamic hypnotherapy. Some patients experience spontaneous alleviation of symptoms when they feel strong enough to cope without the symptoms. Direct suggestions for coping, therefore, are sometimes more effective than direct suggestions for symptom change." (Brown & Fromm, 1986, pp. 194, 195)

Emile Coué and la méthode Coué[edit]

Émile Coué (1923).

The insights, observations, technical developments, and procedural innovations of Émile Coué (1857-1926), the scientist,[6] apothecary (i.e, both a first-contact prescribing pharmacist and a dispensing chemist),[7] hypnotist, and psychotherapist in relation to his understanding, conceptualization, realization, and application of hypnotherapeutic suggestion have greatly influenced the theories and practices of hypnotism throughout the English-speaking world.[8][9][10]

"Continuously, unjustly, and mistakenly trivialised as just a hand-clasp, some unwarranted optimism, and a 'mantra', Coué's method evolved over several decades of meticulous observation, theoretical speculation, in-the-field testing, incremental adjustment, and step-by-step transformation. It tentatively began (c.1901) with very directive one-to-one hypnotic interventions, based upon the approaches and techniques that Coué had acquired from an American correspondence course. As his theoretical knowledge, clinical experience, understanding of suggestion and autosuggestion, and hypnotic skills expanded, it gradually developed into its final subject-centred version—an intricate complex of (group) education, (group) hypnotherapy, (group) ego-strengthening, and (group) training in self-suggested pain control; and, following instruction in performing the prescribed self-administration ritual, the twice daily intentional and deliberate (individual) application of its unique formula, "Every day, in every way, I'm getting better and better". (Yeates, 2016c, p. 55)

Liébeault and "Suggestive Therapeutics"[edit]

Brown's "Affections of the Mind",
as discussed in his Lectures on the Philosophy of the Human Mind.[11]

In 1885, Coué's father-in law, Victor Lemoine, introduced him to Ambroise-Auguste Liébeault,[12] a medical practitioner in nearby Nancy, France. Liébeault, who had earlier dabbled with animal magnetism, and who, now, promoted what he termed "suggestive therapeutics" — "an imperfect re-branding of the 'dominant idea' theory that James Braid had appropriated from [his Edinburg teacher,] Thomas Brown" (Yeates, 2016a, p. 12)[13][14] — based, in part, on an extended, laborious, monotonous, "sleep, sleep, sleep" induction of "hypnosis", and the consequent state of "charme" (i.e., "spellbound") that it produced. Greatly impressed, Coué moved to Nancy, and studied with Liébeault in 1885 and 1886 (Baudouin, 1920, p.13). He returned to Troyes in 1886, and resumed his pharmacy (which had declined in his absence). Convinced of the value of Liébeault's "suggestive therapeutics", he began to experiment with Liébeault's "hypnosis" with his Nancy clientele.[15] Having soon discovered that Liébeault’s techniques were hopeless in practice,[15] he abandoned Liébeault’s "sleep"-based "hypnosis", and hypnotherapy altogether.[15][16]

Correspondence Course[edit]

In 1901, fifteen years later, with the hope of improving his Apothecary business, Coué sent for an advertised free book, Hypnotism as It is (Sage, 1899), which offered to disclose "secrets [of the] science that brings business and social success" and "the hidden mysteries of personal magnetism, hypnotism, magnetic healing, etc.”. His dormant interest in hypnotism reawakened, he purchased the associated correspondence course material produced by the stage hypnotist, "Professor Xenophon LaMotte Sage, A.M., Ph.D., LL.D.", of Rochester, New York (i.e., E. Virgil Neal, the US entrepreneur).[17][18][19]

Neal's course, which was firmly based upon Braid's (Cartesian-reflex) upwards and inwards squint induced "hypnotism" (rather than the dormez, dormez, dormez suggestion-induced "hypnosis" of Bernheim and Liebeault),[20] and the "mental therapeutics" of Thomson Jay Hudson (see Hudson, 1893, 1900, 1903), continuously stressed that suggestion produced outcomes.[21][22] Its approach was entirely consistent with both Braid's "psycho-physiology" (1855, p.855) and Hudson's "mental therapeutics", and concentrated on the transformative power of the subject's mind — the complete opposite of the Liébeault/Bernheim approach,[23] which was centred on the view that, rather than amplifying the effectiveness of suggestion, "hypnosis" made suggestion inescapable,[24] and, consequently, their approach concentrated on the coercive power of the operator's suggestion.[25]

Stott, W.R.S. (1922),
"The Apostle of Auto-Suggestion at Work in his Garden 'Clinic' at Nancy".

John Hartland[edit]

John Heywood Hartland (1901–1977), B.Sc. (Birmingham, 1921), M.B. Ch.B. (Birmingham, 1925), M.R.C.S. (England, 1925), L.R.C.P. (London, 1925), was initially a G.P., practising in West Bromwich, a town in the industrial West Midlands region of England. He later became a consultant psychiatrist, and served as vice-president of the British Society for Medical and Dental Hypnosis, and as editor of the British Journal of Clinical Hypnosis.[26][27]

Convinced that hypnotherapy could be usefully applied, by G.P.s, to a wide range of clinical conditions, regardless of their familiarity with hypnotic theories and practices,[28] at a time that "for many, hypnotism was far from respectable, regardless of whether delivered by a medical practitioner, or not" (Yeates, 2014a, p. 5),[29][30] Hartland delivered lectures, demonstrations, and seminars towards the end of his career throughout the U.K., France, Sweden, Australia, USA, and Singapore.[26][31][32]

Lewis Wolberg and "symptom removal"[edit]

Hartland was greatly influenced by Lewis Wolberg, a strong advocate of the use of hypnotism for symptom-removal, whose approach was derived from that of Ambroise-Auguste Liébeault and Hippolyte Bernheim of Nancy, France.[33]

"Wolberg’s interventions were strong and authoritarian; involving a dramatic induction procedure (to enhance therapist prestige), followed by direct (prestige) suggestions[34] that the subject’s symptoms would disappear upon de-hypnotizing".[35]

This "symptom removal" approach (Wolberg, 1948a) was widely used until, at least, the 1980s: see, for instance, Meares (1960), Slater and Flores (1963), Clawson (1964), Weitzenhoffer (2002), Weitzenhoffer (2004), and Ball (2006), etc.

Hartland and "psychotherapy"[edit]

According to his own account, Hartland had regularly used "hypnosis" in his general practice, since the 1940s,[36] "to facilitate the treatment of various psychosomatic complaints",[37] with his "main object being the removal or alleviation of symptoms to achieve the rehabilitation of the patient and his early return to work".[37]

According to Hartland, because the time pressures of his busy general practice clearly "excluded any serious attempt to employ hypno-analytical techniques" and, having discovered that "direct symptom removal [was] both difficult and unsatisfactory in many cases", he set about "[trying] to evolve a series of standard psychotherapeutic suggestions which [he] could employ at every session before trying to tackle the main symptoms".[37]

Once he had been appointed (in the 1950s) as a consulting psychiatrist to the Hallam Hospital, in West Bromwich, and began working with "six half-day sessions per week in its psychiatric out-patient department", he began to address his professional efforts towards "the more serious psycho-neurotic illnesses".[37] Given that, in the 1960s, according to Barrios (1970), standard psychotherapy (such as Lewis Wolberg’s "short term psychotherapy" and Joseph Wolpe's "behavior therapy") typically involved 20 to 22 sessions, Hartland's initial (conventional) approach was 20 half-hour sessions, with 7-8 minutes of suggestions each hypnotherapy session (1971b, pp. xiv, 203).

Because these interventions demanded a considerable hypnotic "depth", Hartland spent the first three to four of those 20 sessions ensuring that his patients were appropriately prepared/trained[38] — such that, later, they “[could] be induced deeply enough to enter the hypnotic state immediately it was suggested that they should do so" (1971b, p. xiv).[39][40]

Hartland’s "ego-strengthening" monologue[edit]

Hartland, the medical student and emerging hypnotist, would have been very familiar with Coué, the content and rationale of his "Methode", and his contributions to an understanding of "suggestion".

Coué had visited England (conducting group clinical sessions, demonstrations, and lectures) on at least eight occasions between November 1921 and November 1925 (Rapp, 1987). The translation of his Nancy Clinic’s hand-out (1922a) was widely available (1922b, pp.  5-35), with an abridged, rapidly-delivered versions of his presentation available as gramophone recordings (1923a). A further, detailed explanation/elaboration of the rationale behind his "ego-strengthening" suggestions was provided at Coué & Orton, 1924, pp. 80-88. Also, in addition to the many newspaper/magazine reports, a wide range of Coué-centred items were readily available for Hartland’s edification, including reports of Coué’s lectures,[41] eye-witness accounts of visits to Coué’s clinic at Nancy and observations of his interactions with his patients,[42] more detailed accounts of his methode by his 'followers';[43] as well as the items associated with the Coué-Orton Institute.[44]

The first version of Hartland's approach/procedure, and its constituent monologue, was published in 1965 (Hartland, 1965),[45] and reprinted in 1966 (Hartland, 1966).[46] His second version was published in 1967 (Hartland, 1967).[47] The third and final version of his monologue was revealed in a 1970 lecture (Hartland, 1971c); and was reprinted (with appropriate variations for British readers) in the second edition of his textbook (Hartland, 1971b),[48] where the history, structure, rationale, and clinical delivery of his approach were also described.[49] His third version of the monologue was reprinted, without change, in the two posthumous editions of his textbook: viz., Waxman (1989, pp. 219-224), and Heap & Aravind (2001, pp. 127-129).

Alternate versions of Hartland’s "ego-strengthening" monologue[edit]

Hartland was emphatic that the published version of his "ego-strengthening" monologue (a direct transcription of one of his interventions) was provided to deliver an understanding of the suggestive sequence (its critical feature),[50] and that alone — a guide to the "principles underlying the construction and usage of this type of technique" (viz., the "important factors" worth "attention").[3] He stressed that it must never be used exactly as published.[51]

"It is certainly not intended that this [transcript] should be adopted in the precise form that has been described. It is the principle that is worthy of attention, and the sequence [I have] outlined should be regarded simply as a guide to the individual therapist in framing his own suggestions to conform with his own personality, method of approach and style of delivery. It is impossible to suggest here the varying inflections of the voice, but the same cardinal rules of construction, stresses and pauses etc. should be used in order to maintain a rhythmical quality from start to finish."
"In the construction of an ego-strengthening technique, quite apart from the actual suggestions themselves, it is essential that particular attention should be paid to such significant factors as ‘rhythm’, ‘repetition’, the interpolation of appropriate ‘pauses’, and the ‘stressing of certain important words and phrases’. …[also, in order to] avoid excessive monotony … you will notice that [within my version] repetition is often achieved by expressing the same fundamental idea in two or three different ways." — Hartland (1971b), pp.203, 198 (emphasis in original).[52]

"Improved" versions of Hartland's monologue[edit]

A number of "improved" versions of Hartland's "ego-strengthening" monologue have been published — with, perhaps, the most extraordinary being the "Poetic Hypnogram" of Samuel Silber, M.D. (1900–1988), the "Poet Laureate of the American Society of Psychosomatic Dentistry and Medicine"[53] — including, for example, those of Gorman (1974), Stanton (1975), Stanton (1977), Gibbons (1979a), Hutchison (1981, pp. 72-73), Pratt, Wood, and Alman (1988, p. 122-123), Gregg (1990), and Heap (Heap & Aravind, 2001, pp. 129–130), etc., etc.

"Improvisations" upon a theme suggested by Hartland's monologue[edit]

A number of different versions of the "ego-strengthening" monologue, better understood as "improvisations", have also been published: including, for example, those of Jabush (1976), Susskind (1976), Gibbons (1979b), Stanton (1979), Stanton (1989), Barber (1990a), Barber (1990b), Carich (1990), Garver (1990), Torem (1990), Watkins (1990), Wilson and Barber (1990), McNeal and Frederick (1993), Stanton (1997), Milne (1994, pp. 114-117), and Herber (2006, pp. 55-64), etc., etc.

Efficacy[edit]

Using the American Psychological Association's 2002 definition of treatment efficacy ("the systematic and scientific evaluation of whether a treatment works"),[54] it is clear that, despite there being "overwhelming anecdotal evidence of the efficacy of Hartland’s approach, there's little experimental evidence" of it; and this is entirely due to the absence of "genuinely productive experiments", rather than, that is, a proliferation of appropriate, well-constructed, and productive experiments failing to find any such evidence.[55]

Conceptual issues[edit]

Assuming that whatever "measurement" of an object/attribute has been made with a reliable, accurate device, and has delivered a precise value of so-and-so, two important conceptual issues arise in relation to abstractions such as "ego-strengthening":[56]

  • to what degree is the precise value produced by the device (e.g., sphygmomanometer) an accurate measure of the attribute (e.g., blood pressure) in question?
  • to what degree is the presence of the measured attribute (blood pressure) an index of the abstract concept (e.g. ego-strength) that is the ultimate item of interest?

Given the wide range of distinctly different referents to which the expression "ego-strengthening" has been applied by its different users,[57] any appraisal of the efficacy of "ego-strengthening" involves the embedded question "What is being strengthened?" — which immediately demands recognition of the expression’s overall equivocality:[58]

  • Is "ego-strengthening" a generic, qualitative, umbrella term that broadly identifies an overall approach?
  • Is "ego-strengthening" a specific, quantitative term, with "ego" modifying (as a sub-set) the activity denoted as "strengthening"?
    • Does it centre upon the inappropriate "reification" (in the manner of Whitehead's "fallacy of misplaced concreteness") of the abstract concept, "ego"?
    • Is the intervention being delivered with an operator's mind-set that seeks the reduction of a perceived "ego" deficit, or is with one seeking the enhancement of whatever "ego" strength is currently present?[59]

Experimentation[edit]

Setting aside the complex issues of determining precisely how a "genuinely productive experiment" might be constructed, there is the even-more-significant question of the extent to which any such experiment's findings could have any practical application, due to the differences in contexts identified by Gorman (1974):

  • Subjects of "hypnosis under experimental conditions" are "participating voluntarily" in an experiment, have "a detached state of mind", and are not "intimately and vitally" affected by the results of the experiment.[60]
  • Subjects of "hypnosis under therapeutic conditions" are undergoing therapy, and are "acutely aware of the fact that the results of therapy may have a most important effect upon [their] subsequent feelings of well-being"; "[their] state of mind is therefore not detached, but, on the contrary, [they are] both anxious and critical".[60]

In 1977, in reporting perhaps the only investigation that ever attempted to measure the clinical efficacy of Hartland's monologue,[61] Calnan found that patients who had received Hartland's monologue, under hypnosis, 12 times in 6 weeks, demonstrated considerable progress (compared to the others);[62] the most interesting/relevant outcome of his interventions was that:

"[all of the] subjects who received Hartland’s entire treatment procedure … reported feeling more relaxed and self-confident. Very often they described their changes in exactly the same words as those used by Hartland in his ego strengthening suggestions and yet none of the subjects mentioned or seemed aware of their origin." (Calnan, 1977, p. 117, emphasis added).

Utility[edit]

Using the American Psychological Association's 2002 definition of treatment utility ("the applicability, feasibility, and usefulness of the intervention in the local or specific setting where it is to be offered"),[54] Hartland's overall "ego-strengthening" approach, his clinical strategies, his explanations, and his descriptions of the suggestive sequences that he delivered in practice (for within-hypnotic influence and post-hypnotic influence), have made a considerable contribution to modern hypnotherapeutic practice; especially in poorly defined or ambiguous clinical circumstances.

Overall approach[edit]

There are many reports of hypnotherapeutic interventions, directed at a wide range of conditions,[63] that describe the valuable contribution that the adoption of an overall ego-strengthening approach made to their treatment outcomes, in relation to building confidence, enhancing self-esteem, facilitating behavioural change, arousing dormant resources, promoting overall well-being, and increasing a sense of self-efficacy: including, for instance, Gardner (1976); Stanton (1979); Darken (1992); Stanton (1993); Bennett (1994); Vanderlinden & Vandereycken (1994); Moss & Oakley (1997); Daniel (1999); Frederick & McNeal (1999); Hornyak (1999); Linden (1999); Lynch (1999); Mutter (1999); Barber (2001); Phillips (2001); Lavertue, Kumar & Pekala (2002); Stafrace & Evans (2004); and Gafner (2016), etc., etc.

Published monologue[edit]

The literature also contains many reports of Hartland's published ego-strengthening monologue being successfully applied verbatim, as written, to a wide range of complaints: including, for instance, Rose (1967); Basker, Anderson and Dalton (1978); Wakeman and Kaplan (1978); Freeman and Baxby (1982); Gould and Tissler (1984); Finkelstein (1991); Torem (1995); and Spiegel (1996), etc., etc.

See also[edit]

Notes[edit]

  1. ^ Hartland, 1971b, p.196.
  2. ^ According to van Dyck & Spinhoven (1994), ego-strengthening hypnotic techniques (collectively) have certain "common characteristics"; namely, "they aim at suppressing feelings of demoralization or discouragement, at stimulating hope of improvement and finally at supporting efforts to make further progress" (p. 149). Further, they argue, in general terms, the techniques can also be understood as increasing both Franks' (1976) sense of "mastery" and Bandura's (1977) sense of "self-efficacy" (p. 150).
  3. ^ a b Hartland, 1971c, p. 8.
  4. ^ "Ego strengthening [is] the bedrock upon which [most] other [hypno-analytical] techniques are structured” (McNeal and Frederick, 1993, p. 170).
  5. ^ Yeates (2014a), p.4.
  6. ^ "[Coué] could read Latin, spoke fluent German and English, and had both B.A. and B.Sc. degrees before he was 21" (Yeates, 2016a, p. 6).
  7. ^ Initially apprenticed to an Apothecary in Troyes in 1876, where "he learned to examine and diagnose; prescribe and compound medicines; regulate, control, and operate a chemical laboratory; and promote, market, and sell proprietary medicines and his employer’s concoctions", Coué won a government scholarship in 1879 to the prestigious Collège Sainte-Barbe, graduating, with First Class Honours, top of his class, he then "spent six months as a pharmaceutical intern at Paris’s Necker Hospital", before returning to Troyes to take over the operation of the town's largest Apothecary, where he "constantly interacted with people who were, often, extremely sick, involving consultations, diagnosis and prescription, appraisal of treatment efficacy, deciding next treatment, etc." (Yeates, 2016a, pp. 6-7).
  8. ^ Yeates, 2016a, 2016b, 2016c.
  9. ^ According to David Cheek and Leslie LeCron, "Coué made a study of suggestion and learned much about it and how to use it most effectively. Much of our current knowledge of this subject stems from Coué's observations". (Cheek & LeCron, 1968, p. 60; emphasis added to original)
  10. ^ For the francophone world, see Guillemain (2010), Westphal & Laxenaire (2012), etc.
  11. ^ Yeates (2005), p. 119.
  12. ^ See: Gauld, (1992), pp. 319-324; Carrer (2002).
  13. ^ See: Brown (1851), and Yeates (2005); Braid (1843), Carpenter (1852), Carpenter (1853), Braid (1855, p. 852), and Carpenter (1874); Bramwell (1897a), and Bramwell (1897b); Bernheim (1897), and Bramwell (1898).
  14. ^ Also see Bramwell’s "Points of Difference between Braid and the Nancy School as to Suggestion", at pp. 338-339 of Bramwell (1903).
  15. ^ a b c Yeates, 2016a, p.12; 2016c, pp. 56-57.
  16. ^ By, at least, 1913, Coué was observing that Liébeault had been vague, imprecise, and "lacked method" (Baudouin, 1923, pp.18-21); and, further (in 1926) was remarking that, whilst, "in many cases, [Liébeault] got good effects ... he lacked a theoretically correct method, [and, as a consequence,] worked blindly” (Coué, 1926, p.21).
  17. ^ Orton (1935), pp. 59-69.
  18. ^ Sage (1900a/1900b), Sage (1900c/1900d), (Sage 1907/1902); Sage & Adkin (1900a/1900b); and Neal & Clark (1900a/1900b).
  19. ^ Conroy (2014).
  20. ^ According to Yeates (2016a, p. 13), "The [course] materials were unparalleled in their precision, clarity, and direct relevance to the needs of distance-learning students. Students developed presence, confidence, and authority from its exercises (Sage, 1900a/1900b, pp.8-24), and were guided through a number of efficient, Braid-style, upwards and inwards squint induction techniques and efficacious applications of incremental suggestion."
  21. ^ In 1910, Edward B. Titchener (1910, p. 450) stressed that there’s no a priori difference "between [a] suggestive idea and any other idea" — and that, simply put, a "suggestive idea" can only be classed as "suggestive" retrospectively (i.e., only because it has produced a response).
  22. ^ In his 1906 Harvard lectures, Pierre Janet (1920, pp. 284-285) remarked on the significant difference between the operator making a suggestion, and a subject actually taking the suggestion.
  23. ^ As observed by Tuckey (1891, pp. 42-46), and described by Bernheim (1889, pp.206-207).
  24. ^ Bernheim (1889), p.207; COICC (I) (1926), p. 22.
  25. ^ Yeates, characterizes the approach of Liébeault and Bernheim as one of "secular exorcism" (2002, pp. 10-11); and notes (2016a, pp. 8-9) that, "[those] therapeutic interventions (secular exorcisms) that assume humans are illness-prone and seek to identify and expel disease (goal: 'disease-free') are driven by a vastly different mind-set from those interventions (secular invocations) that view humans as robust and health-sustaining, and seek to locate and invigorate the good (goal: 'robust health')".
  26. ^ a b Heap & Aravind (2001, front matter).
  27. ^ D.T.B. & S.N.T. (1978).
  28. ^ See Hartland's articles (1965, 1967, 1968, 1970a, 1971a, 1971c, and 1972); and, in particular his two text-books (1966, 1971b) — which (collectively), included a wide range of induction, deepening, trance ratification, and de-hypnotizing procedures, and (over and above his "ego-strengthening" monologue) a number of additional condition-specific monologues.
  29. ^ Upshaw (2006).
  30. ^ It was not until the late 1950s that national medical associations began to officially endorse the therapeutic applications of hypnotism by their members; see, for instance: British Medical Association (1955a, 1955b), American Medical Association (1958), and Canadian Medical Association (1958).
  31. ^ Noting that Hartland's "ideas and practices were disseminated worldwide", (Yeates, 2014a, p.4) also observes that, from a disciplinary perspective, "Hartland was both medical practitioner and psychiatrist ([which made] him, in a manner of speaking, doubly legitimate)".
  32. ^ "Psychiatrist denies Peril in Hypnosis, The Pittsburgh Post-Gazette, (Friday, 22 Oct 1965), p. 15". Archived from the original on 23 February 2024. Retrieved 23 February 2024.
  33. ^ According to Charles Lloyd Tuckey (1891, pp. 43-44), who had visited Liébeault and Bernheim at Nancy, Liébeault's treatment "consisted essentially in directing the [hypnotized] invalid’s attention on the part affected, and suggesting an amelioration or disappearance of the morbid condition and symptoms".
  34. ^ "Prestige suggestions" are those directives/suggestions the persuasiveness of which are derived from the "prestige" of the individual that delivers them; they are not suggestions that are 'prestigious' within themselves.
  35. ^ Yeates, 2014a, p. 7.
  36. ^ In Hartland (1966, p. xvii), he notes that, rather than being "a complete treatise upon hypnosis", his Medical and Dental Hypnosis and Its Clinical Applications (1966) "is deliberately restricted to a limited field and is based upon a personal experience of some 25 years, much of it gained in general practice and the rest from conducting psychiatric clinics and from lectures and demonstrations given throughout this period". (emphasis added to original).
  37. ^ a b c d Hartland, 1971c, p. 1.
  38. ^ Hartland (1966), pp. 110-111; Hartland (1971b), pp. 116-117; and Waxman (1989), pp. 151-152.
  39. ^ "By their first "ego-strengthening" session, Hartland had co-operative, well-trained, highly receptive patients, who had undergone at least three intense sessions of pre-treatment conditioning (1971b, p.xiv), had their hypnotic talent and propensity to respond to suggestion appraised, had a suitable hypnotic induction determined (Hartland had no 'standard' induction), experienced hypnotizing, deepening and de-hypnotizing processes several times (plus suggestions for future responsiveness), and been convinced, by trance ratification, that they were good hypnotic subjects. These sessions addressed concerns about hypnotism (1971b, p.202), and also increased confidence in Hartland and familiarity with his clinical approach (especially, his manner of speaking)." (Yeates, 2014b, p. 22)
  40. ^ "Trance ratification refers to the process of providing the patient with a convincer, that is, an experience or experiences that ratify for patients that they have been in an altered state of consciousness. It is interesting that sometimes even highly talented hypnotic subjects do not believe they have been hypnotized until they have a ratifying experience. ... Through eliciting various (ratificatory) hypnotic phenomena, patients may come to realize that they have undiscovered potentials beyond their conscious capacities. This realization increases patients' sense of self-efficacy and confidence that they have the inner resources needed to change (Bandura, 1977)." — Hammond, 1990, p. 15.
  41. ^ Huxley, 1922; Littell, 1923, etc.
  42. ^ Kirk, 1922; Aram, 1923; Baird 1923; Glueck, 1923; Stowe, 1923; Noble, 1924, etc.
  43. ^ Baudouin, 1920; Bennett, 1922; Duckworth, 1922; Kirk, 1922; Macnaghten, 1922; Baudouin, 1923; Brooks, 1923, Brooks & Charles, 1923; Mayo, 1923; Orton, 1935, etc.
  44. ^ See Coué & Orton, 1924; COI, 1926; COIC (I)-(VI), 1926; and Orton, 1935, 1942.
  45. ^ The first version of his monologue was approx. 390 words.
  46. ^ This version of the ego-strengthening monologue is at Hartland (1966), pp.191-193. The 1966, first edition of Medical and Dental Hypnosis was published simultaneously in London, by Baillière, Tindall & Cassell, and in Baltimore, by the Williams and Wilkins Company.
  47. ^ This rather different version of his monologue, with certain aspects of the first missing, was approx. 380 words.
  48. ^ This extended final version of his monologue was approx. 750 words.
  49. ^ This version of the ego-strengthening monologue is at Hartland (1971b), pp.199-203. The 1971, second edition of Medical and Dental Hypnosis was published simultaneously in London, by Baillière Tindall, and in Baltimore, by the Williams and Wilkins Company.
  50. ^ According to McNeal (2020, p.395), Hartland's incremental sequence of suggestions were designed to "reinforce progress and help build self-confidence and self-reliance", enhance "general coping abilities", reduce "anxiety and worries", and develop "a positive self-image", and were specifically directed at "physical strength, alertness, reduced self-consciousness, mental clarity, emotional stability and security, optimism and cheerfulness".
  51. ^ For a detailed analysis of the extensive, counterproductive, negatively-expressed language issues within his published transcript — i.e, issues with Hartland's "verbalisation", rather than issues with his overall strategy, embedded principles, and clinical procedure (such as those expressed by Heap (1985), Ross (1985), and Gibson & Heap (1991, pp. 66-67)) — see Yeates (2002) and Yeates (2014b).
  52. ^ In the same vein, stressing the importance of the individual practitioner adapting his [Hartland's] approach to their own circumstances, Hartland observes that, "although I use this scheme [of four preliminary sessions] daily, I do not suggest that it will prove ideal in everybody's hands, or that it should be adopted in its entirety. Anyone who wishes to succeed with hypnosis must formulate his own individual technique through painstaking trial and error, but it is hoped that my experience with this routine may afford some assistance to those who are trying to develop their own particular methods." (Hartland, 1966, p. 111; Hartland, 1971b, p. 117; emphasis added. to original)
  53. ^ Yeates (2014b), pp.32-33; Silber (1980).
  54. ^ a b American Psychological Association (2002), p. 1053.
    Note that the article stresses (p.1052) that its specific focus/target is a discussion of "treatment guidelines" (i.e., "specific recommendations about treatments to be offered to patients"), as distinct from "practice guidelines" (i.e., "recommendations to professionals concerning their conduct and the issues to be considered in particular areas of clinical practice").
  55. ^ Yeates (2014a), p. 14.
  56. ^ See, for instance, Viswanathan (2005), pp. 1-10.
  57. ^ See, for instance, Kernberg (1972).
  58. ^ For instance, does the expression "the German teacher" refer to a school’s German-born teacher of Geography, or to its Edinburgh-born teacher of the German language?
  59. ^ Yeates (2014a), p. 9.
  60. ^ a b Gorman (1974, p. 209.
  61. ^ See McNeal (2020) for a comprehensive survey of the wide range of investigations that have been made into the theories, practices, and outcomes of "ego-strengthening" (however that might be understood) according to a wide range of abstract conceptualizations, theoretical definitions, and clinical applications.
  62. ^ The four groups were: (a) "ego strengthening" suggestions plus hypnosis, (b) hypnosis only, (c) "ego strengthening" suggestions without hypnosis, (d) no treatment. (Calnan, 1977, p. 109).
  63. ^ See, for instance, McNeal (2020).

References[edit]

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