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The Hypnotic Ego-Strengthening Procedure, incorporating its constituent, influential hypnotherapeutic monologue — which delivered an incremental sequence of both suggestions for within-hypnotic influence and suggestions for post-hypnotic influence — was developed and promoted by the British consultant psychiatrist, John Heywood Hartland (1901–1977) in the 1960s.

Hartland's overall ego-strengthening approach was based upon, and derived from, the "Self-Mastery" method that French hypnotherapist Émile Coué (1857-1926) had created, promoted, and continuously polished over two decades of clinical practice (reaching its final form c.1920);[1] and its constituent ego-strengthening monologue[2] was entirely based upon the "curative suggestion" monologue component of Coué's method.[3]

Hartland used his procedure to (pre-therapeutically) strengthen his patients' inner resources[4] — "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",[5] and "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"[6] — and, specifically, the procedure was intended 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 clinical circumstances, on its own, as the sole form of therapy.[7]

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" in the hypnotherapeutic literature;[8] and "ever since then, the concept could be unequivocally named, identified, investigated, productively discussed, and generally understood by all concerned".[9] In addition to providing his monologue's full text, Hartland's 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."[10]
"Ego strengthening began as a specific strategy for hypnotic interventions and evolved into an attitude pervading psychotherapy and clinical hypnotic work. ... Students in hypnosis training should be introduced to an ego strengthening attitude for clinical work, and master specific therapeutic interventions to induce ego strengthening. Such interventions may include guided imagery for self-acceptance and self-love, affirming language that counteracts negative self-talk, age regression to recapture forgotten strengths, and age progression to anticipate and imagine future wisdom and strengths."[11]

Emile Coué and la méthode Coué

[edit]
Émile Coué (1923).

The insights, observations, technical developments, and procedural innovations of Émile Coué, the French scientist,[12] apothecary (i.e., a first-contact prescribing pharmacist, a compounding and dispensing chemist, and a pharmacopolist that sold proprietary medicines), 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.[13][14][15]

"Coué’s method was disarmingly non-complex—needing few instructions for on-going competence, based on rational principles, easily understood, demanding no intellectual sophistication, simply explained, simply taught, performed in private, using a subject's own resources, requiring no elaborate preparation, and no expenditure."[16]
"Most of us are so accustomed ... to an elaborate medical ritual ... in the treatment of our ills ... [that] anything so simple as Coué's autosuggestion is inclined to arouse misgivings, antagonism and a feeling of scepticism."[17]
"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".[18]

Apothecary

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Initially apprenticed to a small 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","[19] Coué won a government scholarship in 1879 to the prestigious Collège Sainte-Barbe, graduating with First Class Honours in Pharmacology, at the top of his class in July 1882. He then "spent six months as a pharmaceutical intern at Paris's Necker Hospital",[19] before returning to Troyes in 1883 to take over the operation of the town's largest apothecary (a different one from the one to which he had been apprenticed), where he "constantly interacted with people who were, often, extremely sick, involving consultations, diagnosis and prescription, appraisal of treatment efficacy, deciding next treatment, etc."[20]

Liébeault and "Suggestive Therapeutics"

[edit]
Brown's "Affections of the Mind",
as discussed in his Lectures on the Philosophy of the Human Mind.[21]

In 1885, Coué's father-in law, the eminent French horticulturist Victor Lemoine, introduced him to Ambroise-Auguste Liébeault,[22] a medical practitioner in nearby Nancy, France. Liébeault, who had earlier dabbled with animal magnetism, and who, now, promoted what he termed "suggestive therapeutics" — i.e., "an imperfect re-branding of the 'dominant idea' theory that James Braid had appropriated from [his Edinburgh teacher,] Thomas Brown" (Yeates, 2016a, p. 12)[23][24] — that was centred, 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 employed a manager for his pharmacy, moved to Nancy, and studied with Liébeault in 1885 and 1886.[25] Coué returned to Troyes in 1886, and resumed the management of his pharmacy (which had declined in his absence). Thoroughly convinced of the value of Liébeault's theoretical position ("suggestive therapeutics"), "on the potential that changes in [a subject's] mind-set offered for relief, amelioration, and cure",[26] Coué began to experiment with Liébeault's "hypnosis" procedure with his Nancy clientele.[27] Having soon discovered that Liébeault's techniques were hopeless in practice,[27] he abandoned both Liébeault's "sleep"-based "hypnosis" and hypnotherapy altogether.[27][28]

Correspondence Course

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In 1901, fifteen years later, with the hope of improving his Apothecary business in Troyes, 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 "Professor Xenophon LaMotte Sage, A.M., Ph.D., LL.D.", of Rochester, New York (i.e., E. Virgil Neal, the US entrepreneur),[29][30][31][32] the successful stage hypnotist who had been admitted to the prestigious Medico-Legal Society of New York in 1899.[33]

Before leaving (in 1895) to become the stage hypnotist, Xenophon LaMotte Sage, E. Virgil Neal had been a lecturer (in bookkeeping, etc.) at the Central Business College in Sedalia, Missouri, where its proprietor Clark W. Robbins (1850-1918) had taught Neal how to identify specific training needs, design coherent courses of study, and construct supportive training materials both for classroom- and distance-learning (Conroy, 2014, pp. 17-27). In March 1898, having abandoned professional stage hypnotism, Neal was commissioned by the New York publishers Williams & Rogers to produce a coherent set of practical, self-instruction textbooks, that emerged in the form of his two ground-breaking textbooks — Modern Banking and Bank Accounting (1899), Modern Illustrative Bookkeeping (1900) — which were intermittently re-issued,[34] as required by various developments in commercial law and business practices, in the form of a single one-volume complete course over more than forty years (Neal & Moore, 1902; Neal & Cragin, 1909, 1911, etc.).[35]

in addition to Sage's Hypnotism as It is (1899) the correspondence course's materials included (a) both the English and French versions of Sage's correspondence course (Sage, 1900a, 1900b, 1900c, 1900d), (b) both the English and French versions of Sage's hints for public demonstrations of hypnotic phenomena (Sage & Adkin, 1900a. 1900b), and (c) Neal's two compendia of contemporary hypnotic knowledge, containing articles from thirty two eminent individual experts (Neal & Clark, 1900a, 1900b, 1900c).[36] Sage's well-structured, distance-learning course was firmly based upon both Braid's (Cartesian-reflex) upwards and inwards squint induced "hypnotism" (i.e., rather than the dormez, dormez, dormez suggestion-induced "hypnosis" of Bernheim and Liebeault), and the "mental therapeutics" of Thomson Jay Hudson (see Hudson, 1893, 1900, 1903). It continuously stressed that suggestion produced outcomes.[37] Its approach was entirely consistent with Braid's "psycho-physiology",[38] and with Hudson's "mental therapeutics"; and, from this, it concentrated entirely on the transformative power of the subject's mind.[39][40]

Sage's approach was the complete opposite of Liébeault and Bernheim;[41] Liébeault and Bernheim's approach was firmly centred on their view that, rather than amplifying the effectiveness of suggestion, "hypnosis" made suggestion inescapable.[42] Consequently, their approach — characterized by Yeates as "secular exorcism" (2002, pp. 10-11):[43][44] — concentrated entirely on the coercive power of the operator's suggestion.[45]

"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')."[46][47]
Emile Coué conducting a clinic in the parlour of his house at Nancy (1923).
Stott, W.R.S. (1922),
"The Apostle of Auto-Suggestion at Work in his Garden 'Clinic' at Nancy".
Émile Coué and his patients in his garden at Nancy (1923).

Hypnotism

[edit]

Having immediately recognised that Sage's Braid-style approach was ideal for mental therapeutics, Coué began an intense study of the course material, and was soon skilled enough to offer hypnotism (free of charge) alongside his pharmaceutical enterprise.[48] As his understanding of suggestion developed, as the efficacy of his interventions increased, and as the popularity of his (free) hypnotherapeutic services increased — and, as the demand for his services grew, and with Coué’s recognition of the duplication of the many common aspects of each of these individual interventions — he began to modify his approach from that of individual, specific, one-to-one interactions to the more generic ego-strengthening sessions with each patient;[49] and, in the process, as his workload increased over the ensuing years, he gradually improved his explanations, his incremental training processes, and the form and content of his ego-strengthening procedure.

Nancy

[edit]

In 1910, Coué abandoned pharmacy altogether, sold his Troyes Apothecary, and moved to Nancy, from whence he continued to offer free-of-charge hypnotherapy treatments to one and all from his residence until his death in 1926.

Formula

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Initially suggested by Neal's associate, Thomas F. Adkin (1900, pp.115-116), and developed into its final form c.1915, Coué stressed that his "formula", "Tous les jours, à tous points de vue, je vaix mieux en mieux" (lit. "Every day, from all points of view, I grow better and better") was, "in practice", "Day by day I am approaching nearer and nearer to what I consider [to be] my physical, intellectual and moral ideal".[50]

John Hartland

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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,[51] and served as vice-president of the British Society for Medical and Dental Hypnosis, and as editor of the British Journal of Clinical Hypnosis.[52][53]

Hartland was 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,[54] 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),[55][56] Hartland's "ideas and practices were disseminated worldwide",[57] through the lectures, demonstrations, and seminars he delivered towards the end of his career throughout the U.K., France, Sweden, Australia, USA, and Singapore.[52][58]

Lewis Wolberg and "symptom removal"

[edit]

Hartland was greatly influenced by Lewis Wolberg, whose strategy of "symptom removal by hypnotic command" (Wolberg, 1948c, p. 1) was derived from the work of Ambroise-Auguste Liébeault and Hippolyte Bernheim of Nancy, France.[59]

"Wolberg's interventions were strong and authoritarian; involving a dramatic induction procedure (to enhance therapist prestige), followed by direct (prestige) suggestions[60] that the subject's symptoms would disappear upon de-hypnotizing".[61]

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

Lewis Wolberg and "ego strength"

[edit]

Assuming the "appropriateness" of the approach and technique chosen by the operator (i.e., their technic),[62] Wolberg (1948a, p. 430) attributed most "therapeutic failures" to (a) "inadequate time", (b) "inadequate motivation", or (c) "diminutive ego strength.[63] From this, Wolberg observed, the appropriateness of the operator's chosen "therapeutic program" was contingent upon three dimensions:

  • The patient's "existing motivations": "what the patient actually seeks out of treatment".[64]
  • The patient's "ego strength or weakness": namely, "the equipment with which the patient can function in treatment".[64][65]
  • The operator's choice of "technic": "the kind of technic [the patient] will be able to utilize most effectively within set limits of time and finances.[64]

Given the importance that he attributed to the dimension of "ego strength" as a significant predictor of therapeutic success,[66] Wolberg was also well aware that,

"The ego strength is more difficult to estimate [than motivation] since adequate criteria have not yet been established. To some extent we may estimate limitations in ego strength from developmental failures of the individual, the incompetence of past and present psychobiologic adaptations, absence of a real precipitating factor, the difficulties in his relations with people, the intensity of dependency, the diminutiveness of self esteem and the inadequacy of his prevailing defenses against anxiety."[64]

Brian Lake and "ego strength"

[edit]

In 1985, the British psychiatrist Brian Lake (1922-2008)[67] observed that "the concept of ego strength is recognised by most psychiatrists, used by some, and defined by few ... [and,] as with the notion of "mental health", many clinicians have an image of ego-strength, but no-one seems fully satisfied with any one else's definition"; "nevertheless, [he continued,] ample evidence exists in textbooks and research articles that the dimension of ego strength and weakness is used as a significant predictor of outcome for psychotherapy, despite its components often being dissimilarly identified, described, and measured".[68]

Lake suggested (p. 473) solving this apparent problem by sidestepping this issue and, simply, presenting the (otherwise ambiguous) "ego strength" as if it were a combination of "personal competence" and "social competence", identifying nine "competencies" (pp. 474-477) which, he claimed, could be objectively observed as present or absent; and, if present, could be "measured in approximate terms of rank ordering, ranging from very much to very little" (p. 477). However, in doing so, Lake warned, whilst competence (i.e., "an overall measure of the ego's ability to interact efficiently with the environment and to perform its adaptive tasks") signified "sufficient strength to perform a task", strength, in and of itself, "[did] not necessarily signify competence" (p. 474).

Hartland and "psychotherapy"

[edit]

According to his own account, Hartland had regularly used "hypnosis" since the early 1940s,[69] "to facilitate the treatment of various psychosomatic complaints" that were presented in his general practice,[70] with his "main object being the removal or alleviation of symptoms [in order] to achieve the rehabilitation of the patient and his early return to work".[70] Given the common-sense understanding of the extent to which "psychological and behavioral factors may adversely affect the course of medical conditions in almost every major disease category",[71] Hartland's interventions addressed two inter-connected psychological issues:

(a) "Those arising as a consequence of the illness itself, such as anxiety, fear, tension and agitation";[72] and
(b) "Those arising from defects in [the patient's] own personality, such as nervousness, lack of confidence, dependence and maladjustment".[72][73]

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" — Hartland 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".[70] Taking advantage of the opportunity offered by the UK's adoption of the National Health Service in the late 1940s, Hartland was appointed as a consulting psychiatrist to the Hallam Hospital, in West Bromwich in the early 1950s.

At Hallam, Hartland began working with "six half-day sessions per week in its psychiatric out-patient department", directing his professional efforts towards "the more serious psycho-neurotic illnesses",[70] with his initial (conventional) treatment approach, consisting of 20 half-hour sessions,[74] with 7-8 minutes of suggestions each hypnotherapy session.[75] 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 trained,[76] and had been convinced that they were talented subjects,[77][78][79][80] ensuring that they could, later, "be induced deeply enough to enter the hypnotic state immediately it was suggested that they should do so" (1971b, p. xiv).[81]

In 1966, Hartland stated that, "for many years now, I have used this ["ego-strengthening"] technique in every case that I treat and have found it to pay handsome dividends. Not only does the patient obtain relief from his symptoms, but he displays improvements in many other ways. He becomes more self-reliant, more confident, and more able to adjust to his environment, and is thus much less prone to relapse".[82] In 1971, in relation to his "ego-strengthening" monologue, Hartland reported that, at Hallam, "when [his] employment of hypnoanalytical techniques was preceded by the same routine sequence of suggestions that had proved so successful in [his] general practice,[83] not only was the average length of treatment substantially shortened, but the need for the more involved analytical techniques was also greatly reduced".[84]

Hartland's "ego-strengthening" monologue

[edit]

Wolberg

[edit]

Despite Wolberg's constant references to the extent to which "ego strength/weakness" predisposed any hypnotherapeutic intervention to success/failure, there are no suggestive sequences (apart from the odd random sentence) in any of transcripts of the thirty recorded sessions of the three "illustrative cases" provided by Wolberg in his publications at (1948c, pp. 40-133), at (1948d, pp. 218-304), and at (1948e, pp. 366-502), that are specifically directed at strengthening "the ego".

Coué

[edit]

In the early 1920s, Hartland, firstly the medical student, and then qualified medical practitioner and emerging hypnotist, would have been very familiar with Coué, with the content and rationale of Coué's "Methode", and with Coué's 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); and a further, detailed explanation/elaboration of the rationale behind his "ego-strengthening" suggestions had been provided at Coué & Orton, 1924, pp. 80-88.

In addition to the many newspaper/magazine reports, a wide range of Coué-centred items were readily available for Hartland's edification,[85] including reports of Coué’s lectures,[86] eye-witness accounts of visits to Coué’s clinic at Nancy and observations of his interactions with his patients,[87] more detailed accounts of his methode by followers,[88] applications in sales and commerce,[89] plus the items associated with the Coué-Orton Institute.[90]

Hartland

[edit]

The first versions of Hartland's ego-strengthening approach/procedure (influenced by Coué's "Self-Mastery" method), and its constituent ego-strengthening monologue (adapted/modified from Coué's "curative suggestion" monologue), were jointly published in 1965 (Hartland, 1965).[91] This version was notable for introducing the convention of ". . ." to indicate pauses in the operator's delivery of the monologue. It was also unique in that it presented complete transcript of the monologue itself.[92] It was reprinted in 1966 (Hartland, 1966).[93]

His second version was published in 1967 (Hartland, 1967);[94] and the third, final version was revealed in a 1970 lecture (Hartland, 1971c), and reprinted (with appropriate variations for British readers) in the second edition of his textbook (Hartland, 1971b),[95] where the history, structure, rationale, and clinical delivery of his approach were also described.[96] 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, "full and unabbreviated version" of his "ego-strengthening" monologue (which was a direct transcription of one of his interventions)[97] was provided to deliver an understanding of the incremental suggestive sequence (its critical feature),[98] and that alone — a guide to the "principles underlying the construction and usage of this type of technique" (viz., the "important factors" worth "attention").[99] He stressed that it must never be used exactly as published.[100][101]

"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).[102]

"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"[103] — 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), Herber (2006, pp. 55-64), and Alladin (2008), etc., etc.

Evaluation

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The American Psychological Association (APA)'s 2002 policy on "treatment guidelines" ("specific recommendations about treatments to be offered to patients"),[104] recommended that treatments be evaluated from two perspectives:

  • Treatment Efficacy: "the systematic and scientific evaluation of whether a treatment works";[105] and
  • Clinical Utility: "the applicability, feasibility, and usefulness of the intervention in the local or specific setting where it is to be offered".[105]

Treatment efficacy

[edit]

Although there's a lot of anecdotal evidence suggesting that Hartland's approach is effective, it has never been rigorously evaluated using scientific methods. This is because — entirely due to the absence of an operationalized definition of "ego-strength" and the lack of a widely accepted "ego-strength" rating scale — no well-designed and productive experiments have ever been conducted. It is not because existing experiments have failed to find evidence of its effectiveness.[106]

Conceptual issues of "measurement"

[edit]

Assuming that whatever "measurement" (presence, absence, degree of change) made of an object/attribute has been made with a reliable, accurate device, and that the measuring device has delivered a precise value of so-and-so, two important conceptual issues arise in relation to abstractions such as "ego-strengthening":[107]

  • to what degree is the precise value produced by the device (e.g., the height of a column of mercury in a sphygmomanometer) an accurate measure of the attribute (e.g., blood pressure) in question?
  • to what extent is the accurately measured value of the selected attribute (blood pressure) an index of the abstract concept (e.g. ego-strength) that is the ultimate item of interest (or not)?[108][109]

Given the wide range of substantially different meanings, conceptualisations, and applications to which the expression "ego-strengthening" has been applied by its many different users (each operating from a different theoretical orientation),[110][111] any appraisal of the efficacy of "ego-strengthening" involves two embedded questions:

  • "What is it that is being strengthened?"; which immediately demands recognition of the expression's overall equivocality:[112]
    • Is "ego-strengthening" a generic (somewhat antiquated) qualitative, umbrella term that broadly identifies an overall approach of mobilizing an individual's inner resources such that they "experience greater inner strength, mastery, self-esteem, and self-confidence" (McNeal, 2020, p. 403): a valuable and productive therapeutic approach — the modern theoretical, practical, and linguistic character of which, Michael Yapko argues (2019a, 2019b), is more accurately and appropriately denoted by the generic descriptor "empowerment".
    • 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")[113] of the abstract concept, "ego"?
      • Is the intervention being delivered from an operator 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?[114]
  • "How is the strength of that entity being measured?"; which immediately raises a number of concerns:
    • To what extent is the attribute being measured (e.g., self-esteem) related to the concept ("ego-strength") under scrutiny?[115][116]
    • To what extent is the measured attribute (e.g., self-esteem) a reliable and valid index of the concept ("ego-strength") under scrutiny?[109][117]
    • To what extent is the (before- and after-intervention) rating of the measured attribute (e.g., self-esteem) a reliable and valid measure of the (before- and after-intervention) "strength" of the concept ("ego") under scrutiny?

Experimentation

[edit]

Setting aside the complex issues of determining precisely how a "genuinely productive experiment" might (or might not) possibly be constructed to measure its efficacy — or how, where, and upon whom a relevant, informative, and useful study might (or might not) be designed and performed — and, further, if were to be conducted, how its results might be measured and appraised, there is the even-more-significant question of the extent to which any such findings could have any practical application at all,[118] 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.[119]
  • 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";[120] "[their] state of mind is therefore not detached, but, on the contrary, [they are] both anxious and critical".[119][121]

In 1977, in perhaps the only investigation that ever attempted to measure the efficacy of Hartland's monologue within a clinical setting,[122] Calnan's study reported that the ten psychiatric patients (test population: 40) who had received Hartland's monologue, under hypnosis, 12 times in 6 weeks, demonstrated (per medium of "psychological tests") considerable progress (i.e., compared to the other 30);[123] 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).

Clinical utility

[edit]

Hartland's overall "ego-strengthening" approach, clinical strategies, explanations, and his descriptions of the suggestive sequences (for within-hypnotic influence and post-hypnotic influence) he delivered in practice, have made a considerable contribution to modern hypnotherapeutic practice. Despite the obvious difficulties in determining its clinical efficacy, Hartland's approach clearly satisfies the APA's tripartite criteria for clinical utility:[124]

  • Generalizability: "the extent to which an effect of a treatment is robust and therefore will be replicated even when details of the context ... [such as] patients’ characteristics, health care professionals’ characteristics, [etc.] ... are altered."[125]
  • Feasibility: "the extent to which a treatment can be delivered to patients in the actual setting", including considerations such as "the acceptability of the intervention to potential patients", "patients' ability and willingness to comply with the requirements of the intervention", and "the ease of administration of the intervention".[126]
  • Cost considerations: these include "the direct, indirect, short-term, and long-term costs to the patient, to the professional ... [including] the cost of any technology or equipment involved in the intervention, and the cost of training ... and to the health care system, as well as the costs associated with withholding treatment" as well as the "cost savings" that might accrue from the intervention's "prevention of future disorders" or its "mak[ing] other treatments unnecessary".[126]

Hartland's overall approach

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There are many reports of hypnotherapeutic interventions, directed at a wide range of conditions,[127] that describe the valuable contribution that the adoption of an overall ego-strengthening approach has made to their treatment outcomes, in relation to building confidence, enhancing self-esteem, facilitating behavioural change, arousing dormant resources, promoting overall well-being, increasing a sense of self-efficacy and self-empowerment, and strengthening the sense of an internal locus of control:[128] including, for instance, Melzack & Perry (1975); Deabler (1976); Gardner (1976); Stanton (1977); Stanton (1979); Newey (1986); Palan & Chandwani (1989); Stanton (1989); Barber (1990a); Barber (1990b); Hammond (1990b); Hammond (1990c); Watkins (1990); 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); Gafner & Benson (2001); Phillips (2001); Lavertue, Kumar & Pekala (2002); Stafrace (2004); McNeal (2007); Chandrashekhar (2016); Gafner (2016); Handel & Néron (2017); Moss & Willmarth (2017); Daitch (2018); and Shenefelt (2018), etc., etc.

Hartland's published monologue

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The literature also contains many reports of Hartland's published ego-strengthening monologue being successfully applied, precisely 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

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Notes

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  1. ^ Waxman, 1989, p 218; Heap & Aravind, 2001, p. 126; Yeates, 2016c, p 68; Moss & Willmarth, 2017, p. 126.
  2. ^ Namely, Hartland 1965, p. 91; 1966, pp. 191-192; 1967, pp. 216-218; 1971b, pp. 199-202; 1971c, pp. 4-7; Waxman, 1989, pp. 219-223); and Heap & Aravind (2001, pp. 127-128). See also: Yeates, 2002; and 2014b.
  3. ^ See: Coué, 1922b, pp. 19-23; and Coué & Orton, 1924, pp. 80-88.
  4. ^ "The true therapeutic value of hypnosis lies in the suggestions made during it." (Freud, 1891/1966, p. 111)
  5. ^ Hartland, 1971b, p.196.
  6. ^ Torem, 1990, p. 110.; Torem continues: "In my opinion, ego-strengthening is a technique that is indicated for all patients who come to us looking for an alleviation of their suffering regardless of what their symptoms are. It is like saying that healthy and good nutrition is helpful to all patients regardless of what their diagnosis or illness is." (loc. cit.)
  7. ^ "In my own psychiatric practice some 70% of my patients recover as a result of the "ego-strengthening" technique alone, usually well within Wolberg's suggested limit of 20 sessions of short-term psychotherapy". (Hartland, 1971c, p. 8)
  8. ^ "Ego strengthening [is] the bedrock upon which [most] other [hypno-analytical] techniques are structured” (McNeal and Frederick, 1993, p. 170).
  9. ^ Yeates (2014a), p.4.
  10. ^ Brown & Fromm, 1986, pp. 194, 195.
  11. ^ Moss, Willmarth & Reid, 2024, p. 831.
  12. ^ "[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).
  13. ^ Yeates, 2016a, 2016b, 2016c.
  14. ^ 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)
  15. ^ For the francophone world, see Guillemain (2010), Westphal & Laxenaire (2012), etc.
  16. ^ Yeates, 2016a, p. 8.
  17. ^ Duckworth 1922, pp. 3–4.
  18. ^ Yeates, 2016c, p. 55.
  19. ^ a b Yeates, 2016a, p. 6.
  20. ^ Yeates, 2016a, p. 7.
  21. ^ Yeates, 2005, p. 119.
  22. ^ See: Gauld, (1992), pp. 319-324; Carrer (2002).
  23. ^ 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).
  24. ^ Also see Bramwell's "Points of Difference between Braid and the Nancy School as to Suggestion", at pp. 338-339 of Bramwell (1903).
  25. ^ Baudouin, 1920, p. 13.
  26. ^ Yeates, 2016c, p. 67)
  27. ^ a b c Yeates, 2016a, p.12; 2016c, pp. 56-57.
  28. ^ 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).
  29. ^ Although some had (mistakely) supposed, at the time of Coué's American visit, that Coué's source had been Sidney Abram Weltmer, in 1923 Weltmer himself emphatically stated that Coué's source was Sage/Neal, Weltmer's one-time teaching colleague in Sedlia (Cousley, Sam, "Missourian Was First To Use Day By Day Formula In Cures, The Dubuque Telegraph-Herald, Monday, 5 February 1923, p. 12.
  30. ^ Orton (1935), pp. 59-69.
  31. ^ Namely, Sage (1900a/1900b), Sage (1900c/1900d), (Sage 1907/1902); Sage & Adkin (1900a/1900b); and Neal & Clark (1900a/1900b).
  32. ^ Conroy (2014).
  33. ^ p.399 of Medico-Legal Society of New York (1899), "Transactions: Annual Meeting, December 1899", Medico-Legal Journal, 17(3), pp.399-402.
  34. ^ According to one of Neal's friends and former Sedalia colleague, Fred Tamblyn (e.g., Tamblyn, 1911), the rights to both books were sold to the American Book Company in 1900. Neal's share of the sale was a third of a million dollars (Filkin, 1932) — almost $14 million in 2024 value — at a time when "the average salary of a bookkeeper was $75 per month" (Conroy, 2014, p.25). The re-issues retained Neal's name as the primary author, and listing the Boston educator, John Henry Moore (1874-1909), as Neal's "banking" co-author, and the Worcester educator, Charles Thompson Cragin (1854-1925), as Neal's 'bookkeeping" co-author.
  35. ^ Although specifically designed for distance-learning, they also served as standard texts in U.S. business colleges for many years; and were still being used by Indiana State University in the 1940s (Conroy, 2014, p.27).
  36. ^ 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 (see 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."
  37. ^ 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).
  38. ^ By 1855, Braid's on-going, deliberate, and extended clinical experience of the wider applications of hypnotism and its associated phenomena (ever since his initial discovery of hypnotism in November 1841) had convinced him that, rather than the "communicat[ion of] any surcharge of a magnetic, odylic, electric, or vital fluid or force, from [the operator's] own body to that of the patient", being "the real and efficient cause of the efficient cause of the phenomena that follow [hypnotization], in [the] altering or modifying physical action, or curing disease", it was that the operator, who was merely "the engineer" (i.e., not the "engine"), "by various modes, exciting, controlling, and directing the vital forces within the patient's own body, according to the laws which regulate the reciprocal action of mind and matter upon each other, in the present state of our existence."
    From this, he proposed, a "more appropriate ... generic term" for the enterprise in question would be "psycho-physiology" (Braid, 1855, p. 852, emphasis in original).
  39. ^ According to Sigmund Freud (1891/1966, p. 111), "suggestions" were goal-directed communications; according to Charles Baudouin (1920, p. 26), echoing Brown, Braid, and Carpenter, "suggestion" was the ideodynamic means through which suggestions are realised; and, as Pierre Janet stressed in his 1906 Harvard lectures (1920, pp. 284-285), there was a significant difference between the operator making a "suggestion", and a subject actually taking the suggestion.
  40. ^ It is significant that the career of the French parapsychologist Michel Moine also began with Sage's course.
  41. ^ As observed by Tuckey (1891, pp. 42-46), and described by Bernheim (1889, pp.206-207).
  42. ^ Bernheim (1889), p.207; COICC (I) (1926), p. 22.
  43. ^ A typical Liébeault intervention, as observed by Tuckey, once "hypnosis" had been induced, had many similarities to an exorcism/banishing ritual:
    "The patient being more or less influenced, Dr. Liébeault now proceeds with the treatment proper. This consists essentially in directing the invalid's attention to the part affected, and suggesting an amelioration or disappearance of the morbid condition and symptoms. To take a very simple case — let us suppose that the malady is chronic nervous headache. The part of the head affected is gently rubbed [by Liébeault], so that the patient's attention shall be attracted to it, and he is told [by Liébeault] that the pain is to disappear — that he will awake feeling his head cool, clear, and comfortable, and that there is to be no return of the trouble. In ordinary cases the whole process will not have lasted more than five minutes when Dr. Liebeault brings it to a close by arousing the patient, which he does by telling him to open his eyes and awake. This is generally enough; he awakes as from ordinary sleep, and is told to vacate the armchair in favour of the next patient." (Tuckey, 1891, pp. 43-44).
  44. ^ This secular exorcism approach was entirely consistent with Freud's "psychotherapeutic operations" — which Freud, who had spent a month in 1889 observing Bernheim in Nancy, and later translated two of Bernheim's publications (Bernheim, 1886, 1891) into German (Bernheim, 1888, 1892), described as "analogous to [scraping out] a cavity filled with pus" (1895/1955, p.305) — the sole purpose of which was the attenuation of anxiety and the conversion of neurotic distress into normal human misery [sic].
  45. ^ Consistent with the mesmerists' (earlier) position, that the directed "power" of an operator's "will" could (mentally) influence a mesmerized subject (see, for instance, Thompson (1845); Ashburner (1847); Thompson (1847); and Lewis (1848), etc.).
  46. ^ Yeates (2016a), pp. 8-9).
  47. ^ For Charles Baudouin, who had observed and studied with Coué for 18-months at Nancy (c.1910), Coué's approach involved invoking health, rather than banishing disease. Using an analogy to exorcism Baudouin wondered why others made such a therapeutic effort, in effect, to banish "Satan", when all that was needed was to invoke the presence of "God":
    "Veni Creator is, in all respects, a far more potent exorcism than Vade retro Satanas. We get rid of evil by filling its place with good." (Baudouin, 1920, p.180)
  48. ^ It is important to recognise that (like Hartland) Coué’s undoubted possession of hypnotic skill contrasts strongly with other so-called hypnotic "experts" (such as Jean-Martin Charcot, of the Salpêtrière, who never performed a single hypnotic induction in his entire professional career (Gauld, 1992, p.314)); and, moreover, despite Coué's dedication to auto-suggestion and the Coué methode, he continued to actively use formal hypnotism and direct suggestion until his death (see Baudouin, 1920, pp. 257-258).
  49. ^ "[Coué's] decision to devote his burgeoning hypnotherapeutic skills to group interactions forced him (most fortuitously) to concentrate on what his patients had in common; not how they differed. So, rather than (micro-level) individualised disease-banishing, he set about working (meta-level) to generate harmonious mental processes, and to arouse, motivate, and liberate underperforming, dormant, or latent aspects of the vis conservatrix naturæ, ‘sustaining force of nature’, and the vis medicatrix naturæ, ‘healing force of nature’, in all of his patients." (Yeates, 2016c, p. 67.)
  50. ^ Orton, 1935, p.183, emphasis in original.
  51. ^ At that time, the fact that "Hartland was both medical practitioner and psychiatrist [made] him, in a manner of speaking, doubly legitimate" (Yeates, 2014a, p.4).
  52. ^ a b Heap & Aravind (2001, front matter).
  53. ^ D.T.B. & S.N.T. (1978).
  54. ^ 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.
  55. ^ Upshaw (2006).
  56. ^ 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).
  57. ^ Yeates (2014a), p.4.
  58. ^ "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.
  59. ^ 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".
  60. ^ "Prestige suggestions" are directives/suggestions, the persuasiveness of which, are derived from the imputed "prestige" of the individual that delivers them; they are not suggestions that are 'prestigious' within themselves. According to Murphy, Murphy & Newcomb (1937), this "prestige" is due to a subject's emotional response: viz., "the tendency to believe or to do what one is told because of social motives such as dependence upon, or fear of, or fondness for, some person" (p.169). Consistent with McDougall's (1921) view that "suggestion is a process of communication resulting in the acceptance with conviction of the communicated proposition in the absence of logically adequate grounds for its acceptance" (p. 100, emphasis in original), Wegrocki's (1934) studies emphasized the extent to which the influence of "prestige" suggestion depended upon a subject's ""prestige" suggestibility" (i.e., "their uncritical acceptance of the opinions of others" (p. 385)).
  61. ^ Yeates, 2014a, p. 7.
  62. ^ Wolberg, 1948a, p. 206.
  63. ^ As Lake (1985, pp.473-475) stresses, Wolberg's notion of a diminished "ego strength" was precisely that: impaired (less robust, less coherent, etc.) in relation to what it was before, for that particular individual; not what it currently is for that individual, compared with that of an average (or ideal) individual; and, as Yeates (2014a, p. 9) observes, "often the impairment was due to factors other than the treated condition: unassociated illness, surgical intervention, physical injury, previous psychotherapy, stressful life events (Holmes and Rahe, 1967), prescribed medication, recreational drugs, etc.".
  64. ^ a b c d Wolberg, 1948a, p. 230.
  65. ^ Based upon Wolberg's view that treatments delivered to subjects with stronger "egos" would prove to be more efficacious, Frank Barron developed a rating scale — the Barron Ego Strength Scale (BESS) (Barron, 1953a, 1953b) — that claimed to measure a subject's overall "adaptability" and "personal resourcefulness", and, therefore, according to Barron, provide a means of predicting those subjects that might benefit from psychotherapy (and, as well, according to Barron, provide a rating that could be considered to represent an index of the individual subject's "ego-strength") (1953b, pp. 327, 333).
  66. ^ A view also strongly held by Kernberg (1972).
  67. ^ Mindham, R.H.S. & Sims, A.C.P. (2008), "Brian Lake: Formerly Consultant Psychotherapist, Leeds", Psychiatric Bulletin, 32(8), p. 319. doi:10.1192/pb.bp.108.021618
  68. ^ Lake, B. (1985), "Concept of Ego Strength in Psychotherapy", The British Journal of Psychiatry, 147(5), pp. 471-478, p. 471. doi:10.1192/bjp.147.5.471
  69. ^ 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).
  70. ^ a b c d Hartland, 1971c, p. 1.
  71. ^ Stoudemire (1995), p. 187.
  72. ^ a b Hartland 1965, p. 190.
  73. ^ Hartland (1971c) noted that his sequence of "ego-strengthening" suggestions was "intended to improve the patient's general condition, to strengthen his weaknesses, to increase his confidence, and to allay his anxieties"; and, further, that it was "designed, not only to alleviate most of the complaints made by the average neurotic, but also to improve and mitigate those defects which have contributed largely to his illness" (p. 6).
  74. ^ According to Barrios (1970), standard psychotherapy in the 1960s, such as Lewis Wolberg's "short term psychotherapy" and Joseph Wolpe's "behavior therapy", typically involved 20 to 22 sessions.
  75. ^ Hartland, (1971b), pp. xiv, 203.
  76. ^ In similar vein, although Milton Erickson "frequently did brief therapy" (Hammond, 1984, p. 242), Erickson reported — based upon his "personal experience extending over 25 years with a total of well over 3,500 hypnotic subjects" — the routine engagement with his subjects in "four to eight hours of initial induction training" before commencing any treatment (1952, p. 76).
    In his 1957 "Ocean Monarch Lectures", Erickson stated that he had "seen patients for as long as 16 consecutive hours"; and, depending on their condition, the frequency of his regular (2-4 hour) consultations ranged from "from once a month to [as many as] seven sessions per week" (Erickson and Rossi, 1981, pp. 18-19).
    Moreover, in 1974, Erickson stated that, even after "after hours of previous hypnotic training ... [he] rarely [gave] therapeutic suggestions [to his subject] until the trance [had] developed for at least 20 minutes" (Erickson & Rossi, 1974, p. 238).
  77. ^ In doing so, Hartland was following Wolberg's directive: "Hypnoanalysis presupposes the fulfillment of a number of requirements on the part of both the patient and the therapist. The patient must be hypnotizable and must have been trained to reach as deep a trance state as possible. The therapist must understand unconscious dynamisms and must know how to manipulate the hypnotic interpersonal relationship in the interest of therapeutic objectives." (Wolberg, 1945, p. 170, emphasis added)
  78. ^ Hartland (1966), pp. 110-111; Hartland (1971b), pp. 116-117; and Waxman (1989), pp. 151-152.
  79. ^ "Suggestions are carried out very much better where the patient is convinced that hypnosis can have a potent influence on his functions. It may therefore be advisable to delay giving therapeutic suggestions until he achieves as deep a trance as possible, and until he gains confidence in his ability to experience the phenomena suggested to him. ...
    The employment of therapeutic suggestions at a time when the patient is skeptical about his ability to comply, and before he has gained sufficient confidence in himself and in the physician, may end in failure and add discouragement and panic to the patient's difficulties. A deep trance seems to increase therapeutic effectiveness in most patients." (Wolberg, 1948c, p.30)
  80. ^ "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, 1990c, p. 15.
  81. ^ This meant that, "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 [preparatory] 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)
  82. ^ Hartland (1966), p. 190, emphasis added.
  83. ^ Hartland noted that his overall "ego-strengthening" approach was based on more than 30 years' experience, "the first ten in general practice and the last twenty in psychiatric practice" (1971c, p.2).
  84. ^ Hartland (1971c), pp. 1-2.
  85. ^ According to its publisher, Stanley Unwin, although "scarcely any copies of Baudouin's Suggestion and Autosuggestion were sold during the first three months following publication", based upon the good press reviews, it continued to sell well for the next 50 Years (Unwin, 1976, p.216). About 180,000 copies of Brooks' Practice of Autosuggestion — which was specifically "commissioned to meet the demand for a cheaper and more popular book that [they] were confident that Baudouin's [work] would arouse" — were sold in the UK and in America over the next couple of years (Unwin, 1946, p.319). Further, according to Thomson (2006, fn. 126), by the time that the two items were combined in 1960 — viz., as Coué and Brooks' Better and Better Every Day: Two Classic Texts on the Healing Power of the Mind — Brooks' Practice of Autosuggestion was in its 16th impression, and Coué's Self Mastery through Conscious Autosuggestion was in its 16th impression.
  86. ^ See: Huxley, 1922; Littell, 1923, etc.
  87. ^ See: Kirk, 1922; Aram, 1923; Baird 1923; Glueck, 1923; Stowe, 1923; Noble, 1924, etc.
  88. ^ See: Baudouin, 1920; Bennett, 1922; Duckworth, 1922; Kirk, 1922; Macnaghten, 1922; Baudouin, 1923; Brooks, 1923, Brooks & Charles, 1923; Mayo, 1923; Orton, 1935, etc.
  89. ^ See: Scott, 1923, etc. According to Wendy Larson (2019), "Coué's ideas expanded into commerce, where business leaders found in its optimism-enhancing approach an excellent tool to increase sales, celebrate social mobility, build personal autonomy, and create satisfaction" (p. 210).
  90. ^ See: Coué & Orton, 1924; COI, 1926; COIC (I)-(VI), 1926; and Orton, 1935, 1942.
  91. ^ The first version of his monologue was approx. 390 words.
  92. ^ According to Von Dedenroth (1964), the standard presentation of hypnotism-centred interventions, within the disciplinary literature of the day, was of little use: "When written in regard to a specific problem, most discussions of hypnotic induction are not instructive, i.e., 'A trance-like state was induced and suggestions made that the patient stop smoking'." (p. 33)
  93. ^ 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.
  94. ^ This rather different version of his monologue, with certain aspects of the first missing, was approx. 380 words.
  95. ^ This extended final version of his monologue was approx. 750 words.
  96. ^ 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.
  97. ^ Over time, Hartland continued polishing his 1965 version, "constantly changing the sequence and nature of the routine suggestions, omitting some, re-wording others, and including entirely new ones" (Hartland, 1971c, p.1), until it reached its final form in 1971.
  98. ^ 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".
  99. ^ Hartland, 1971c, p. 8.
  100. ^ This is entirely consistent with Wolberg's insistence on an 'individual approach":
    "[In giving suggestions,] it is essential to adapt one's language to the patient's intelligence and to his education. Many failures in symptom removal are due to the fact that the patient does not clearly comprehend what the hypnotist is trying to convey to him." (Wolberg, 1948b, p. 3).
  101. ^ 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).
  102. ^ 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)
  103. ^ Yeates (2014b), pp.32-33; Silber (1980).
  104. ^ APA (2002), p. 1052; as distinct from "practice guidelines" ("recommendations to professionals concerning their conduct and the issues to be considered in particular areas of clinical practice").
  105. ^ a b APA (2002), p. 1053.
  106. ^ Yeates (2014a), p. 14.
  107. ^ See, for instance, Viswanathan (2005), pp. 1-10.
  108. ^ Precise, accurate measurement is never enough: for instance, despite the objective, precise accuracy of their cranioscopic measurements, none of the assertions made by phrenologists — that a cranium's topography (so-measured) was an index of a particular individual's propensities, traits, and faculties, etc. — have ever been substantiated.
  109. ^ a b The principle of the identity of indiscernibles, widely known as Leibniz's Law, tells us that, to the extent that A and B are the same, whatever you observe about A also obtains to B.
  110. ^ ""Ego strength" is not necessarily a homogeneous entity. Certain parts may be strong at the same time that others are weak. Because it depends on the relationship between various functions, its strength can be viewed from two perspectives:
    (a) the degree to which the functions continue to operate when placed under load; and
    (b) the degree to which impaired functions are restored to efficiency" (Yeates, 2014a, p. 9).
  111. ^ See, for instance, Kernberg (1972) for instances of that wide range.
  112. ^ For instance, does the expression "the German teacher" refer to a school's Berlin-born teacher of Geography, or to its Edinburgh-born teacher of the German language?
  113. ^ Namely, the (mistaken) belief that, "[just] because there are certain words, there must necessarily be certain "things" that correspond to them" (Caldwell, 1990, p. 30).
  114. ^ Yeates (2014a), p. 9.
  115. ^ In his examination of "Self-Esteem, Hypnosis, and Ego-Enhancement", Stafrace (2004, pp.29-30) noted that, despite there being evidence that "high self-esteem [was] associated with adaptive functioning and personal competence", and evidence that there was "an association between low self-esteem and a number of clinical and dysfunctional attitudes and behaviours", the crucial question of whether the significance of "self-esteem [was] as a predisposing, precipitating, or maintaining factor" in these outcomes had never been satisfactorily determined.
  116. ^ Also, according to Stafrace (2004):
    "Low self-esteem is correlated with a number of personality characteristics including dependency, the need for approval, helplessness, apathy, feelings of powerlessness, isolation, withdrawal, submissiveness, and compliance. Masked hostility, passivity, and a tendency to downgrade or denigrate others or project one's failings onto others are also significantly correlated with low self-esteem. Poor self-regard predisposes the individual to reduced ability to choose jobs suited to one's needs and abilities, a diminished association between task performance and satisfaction, a tendency to accept unfavourable assessments as accurate, less likelihood of scholastic success, and vulnerability to interpersonal problems in adolescence. In the elderly, low self-esteem is associated with poorer health, more daily pain, greater disability, and increased somatisation, together with anxiety and depression." (p. 18)
  117. ^ According to Viswanathan (2005, pp.5-10), the "conceptual distance" between an abstract concept and its measurement has a direct bearing on the reliability and veracity of that measurement. For instance, the "conceptual distance" between the length of a pencil and the marks on the edge of the steel ruler used to "measure" it is much smaller than, say, the "conceptual distance" between an attitude to an issue and whatever has been chosen to measure it — and, as Viswanathan warns (p. 7), these "larger distances ... have at least two implications, As the distance increases, so, too, do measurement error and the number of different ways in which something can be measured."
  118. ^ See, for instance, Heap, 2011.
  119. ^ a b Gorman (1974, p. 209.
  120. ^ Also, given that they are presenting for treatment — and, ipso facto, manifest a response expectancy (see, for instance, Kirsch, 1997) — they are, ceteris paribus, far more likely to respond to suggestion:
    "When a patient comes for treatment, and is really in search of health, no matter how little he may appear to be in harmony with the suggestions given, his very search for health creates a sympathy for suggestions, since he would really like to believe and accept them." (Parkyn, 1900, p.15).
  121. ^ In contrast to experimental situations — wherein operators apply the processes under scrutiny in the same, standard way to all subjects — the operators in therapeutic situations variously apply the processes to their individual subjects, according to the circumstances of the moment, in an intuitive and spontaneous way (van Dyck & Spinhoven, 1994, p.149). Moreover, as Heap (2011, p. 27) observes, "The working models of hypnosis that ... clinical practitioners of hypnosis ... adopt will be those best suited to their needs and those of their patients or clients and these may not necessarily coincide with those of the ... laboratory and clinical research ... experimentalists".
  122. ^ 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.
  123. ^ The four groups of 10 were: (a) "ego strengthening" suggestions plus hypnosis, (b) hypnosis only, (c) "ego strengthening" suggestions without hypnosis, (d) no treatment (Calnan, 1977, p. 109). Calnan also noted that "those on medication had been stabilised on chemotherapy for some time and no changes in dosage were made during the research" (p. 110).
  124. ^ APA (2002), pp. 1056-1058.
  125. ^ APA (2002), pp. 1056.
  126. ^ a b APA (2002), pp. 1057.
  127. ^ See, for instance, McNeal (2020).
  128. ^ Further, as Reid and Christensen (2024) observe, "ego-strengthening suggestions [given within the hypnotic intervention] ... can also [be of the nature, form, and content] that in turn can also serve as posthypnotic suggestions for continued and expanded benefit of using self-hypnosis to reduce symptoms of anxiety" (p. 433).

References

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https://ia600200.us.archive.org/29/items/lecturesonphilos00browuoft/lecturesonphilos00browuoft.pdf Lectures on the Philosophy of the Human Mind (Nineteenth Edition), Edinburgh: Adam & Charles Black.]

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