The Clinical Importance of Sociocognitive Models of Hypnosis

Man. This paper is a weird find. Reading a paper from Lynn about Erickson is like going to a fine restaurant where they slather their steak with ketchup. I’m a big fan of sociocognitive perspectives, not so much of the weirdness Erickson managed to get up to. I don’t intend to summarize the paper, just highlight what I found interesting.

In the intro - they mention they’ll be expanding on the response sets, how social and cognitive components play a role in them, and how this applies to Erickson’s approach. As gen Z says - fucking bet.

Sociocognitive Theories for the Haters

They start off by highlighting common misconceptions about sociocognitive perspectives - specifically that they don’t think people are just pretending or roleplaying. There’s some amusing condescending wonka vibes in here…

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.

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

In short - they agree response can’t be reduced to simple compliance and faking.

Sarbin and Coe’s theory hypnosis could be thought of as “believed in imaginings,” creating their role theory. In their theories, they highlighted the importance of:

• The subject knowing what’s required of them
• How the perceived their role as subject (social context)
• What they expected
• Their imaginative abilities
• “Demand characteristics”
• Self deception (Linking to Gorassini here since I think they’ve got the same idea)

TX Barber thought hypnotic response could be explained through normal (non-state) abilities like dissociative capacities, imagination, and attitude. They highlighted a compelling part of the ritual was the ability for the therapist to speak to the client in a way that’s not possible in conversation. (A more polite way of putting that you won’t be interrupted when giving therapeutic suggestions, hypnotic or not.)

Spanos posited a multifactorial model, incorporating Barber’s ideas. The subject’s “attitudes, beliefs, imaginings, attributions, and expectancies” all take part in response. Also Spanos came up with the idea of GDFs (goal directed fantasies.) A big contribution from Spanos (and Gorassini) was the CSTP, which demonstrated that hypnotic response could be modified.

Kirsch came up with the massively influential response expectancy theory. They regularly heralded hypnosis as a “non-deceptive placebo.” Interestingly, their theory builds on Rotter’s social learning theory, creating space non-volitional responses. It’s all in on expectancies and motivation.

Expectancies help us draw some neato conclusions - which I’m quoting directly so I don’t muddy up the nuance.

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).

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

Lynn (and others) came up with the integrative model. It brings together “situational, intrapersonal, and interpersonal variables.” Instead of leaning on fantasy, self deception, compliance, conformity, and waking suggestion (expectancy,) they placed more importance the relationship and “unconscious determinants.” All the other stuff helps, but people don’t need to be particularly skilled or gifted in those areas to respond. The TLDR of the application model is mostly talk with your co-operator, listen, build trust, encourage active engagement, tailor your suggestions, and don’t set them or yourself up for failure.

Looks like this paper leave’s off on Kirsch and Lynn’s earlier response set theory, a predecessor to the integrative response set theory. The response set theory posts that all behaviors are unplanned and automatic. Response sets include “schemas,” scripts, associations, and conditioned (operant or classical) responses to stimuli. Schemas are like little rules outside of awareness for what behavior to emit.

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).

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

Unrelated, but now I get why so many sociocognivists are super salty about the Spiegels.

Once again, contrary to Spiegel’s (1998) contention, subjective experiences are accorded an important place in a sociocognitive theory of hypnosis.

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

Erickson through a Sociocognitive Lens

Oh man. THIS is the stuff I read papers for.

Cutting the niceties and fluff, they introduce their view on Erickson:

• Erickson excelled at working with automatic responses and behaviors, often by targeting them in an indirect away, often outside of awareness.
• While the authors aren’t a fan of the concept of trance, they concede the presentation of trance as a flow of automatic responses is acceptable, even useful.
• Aside from the concept of trance, many of Erickson’s procedures line up within the response set theory, just using different language.

Priming

In the case of Joe (the gardener with terminal cancer), this uses a metaphor as priming. I feel like this is often conflated with subliminal messages. The point of priming is to seed ideas and prepare someone for an experience, or to think of something differently. They cite an example of a study where a romantic song was on radio in the background, and then had test subjects sit close to someone of the opposite sex, observing how flirty they got.

The technique is to give someone an idea with the hope they’ll recontextualize it later.

Scripts

This isn’t about scripts in the hypnotic sense - but scripts as far as automatic behavior in response to a stimulus or situation. They provide the Xerox experiment as an example of this. This is where we get to “yes sets,” which the paper amusingly gets around calling them a dirty NLP word by labeling it “yea saying.” Simply, subtly build easy, automatic agreement.

Altering Accessibility

This is similar to priming - getting someone to imagine another outcome. “What would it be like if X?” or “What would/will happen/what would change if X?” Or do it the Ericksonian Way™️ and give an anecdote or metaphor. You can also ask questions that would imply their problem is solved, rather than looking directly at the problem, priming them to look for changes they can make.

Utilization

If you’re reading this document, you already know what utilization is from a fun-zone hypnosis perspective. Erickson would utilize whatever the patient did and build on it, rather than try to replace it. Put more bluntly, anything you’re doing is reframed as a sign you’re going into trance/hypnosis. (Or in a more therapeutic sense, they’d try to shape behaviors instead of replace them.)

Cooperating

Erickson would…

• Avoid reactance by attacking problems indirectly
• Agree with the client so long as it worked to his favor. (EG - he wouldn’t tell a client they weren’t Jesus. They’d just highlight that Jesus was a carpenter and get them a job.)
• If the patient was resisting, they’d ask them to deliberately recreate the symptoms ailing them. That way, if they resisted, it’d have therapeutic benefit. (Or, if they’re resisting hypnosis, they’d just ask them to do the opposite.)

The paper highlights that while Erickson had luck using indirect suggestions, there’s nothing that proves they’re more effective than direct suggestions. (On a personal note, I think the distinction between direct and indirect is a waste of time at a certain point.)

Working With Resistance

If someone didn’t want to go along with a suggestion (ala reactance,) he’d ask them to do something he expected them to not comply with. After they were able to resist without repercussions, they’d be more likely to comply with later suggestions (that Erickson actually cared about.)

To work with reactance, Erickson would give the client multiple options instead of prescribing just one. They assumed this would let the client commit to their choice in the decision, rather than deciding not to do something.

Effort

If people put more effort into something, the more likely the behavior will stick. Clearly, this never backfires. /s

Erickson was known for giving clients ridiculous ass assignments (like climbing a mountain.) The paper has a kinder take than I do, but he’d take credit for any therapeutic benefit the client had.

Conclusion

This part of the paper is… without the dressing, a plead to therapists to try science and evidence based strategies and highlights Ericksonian approaches that match sociocognivist theories.