RECENT EXPERIENCES with GESTALT, ENCOUNTER and HYPNOTIC TECHNIQUES SIDNEY ROSEN HEALTH - OR FLIGHT INTO HEALTH? Own Thoughts

Home , Fritz Perls, Gestalt therapy, Karen Horney

*RECENT EXPERIENCES WITH GESTALT, ENCOUNTER AND HYPNOTIC TECHNIQUES SIDNEY ROSEN HEALTH - OR FLIGHT INTO HEALTH? own thoughts. When he made a comment about the behavior of one of the I HAD been treating a 35 year old pro- young women in the group, I took the fessor for about two years. Among his opportunity to challenge him to stand most disturbing concerns were his up, walk across the room and express homosexual compulsion to visit res- his feelings towards this woman. He trooms and his inability to complete the insisted that he could not even stand up. manuscripts required for his profes- The group then spent 20 minutes urging, sional advancement. For one year he challenging and encouraging him to try. had been attending group therapy ses- He seemed to shrink further and further sions once a week in addition to in- into his seat. Then, when attention to dividual psychotherapy sessions every him was momentarily diverted, he quick- second week. ty got up, made a half-hearted show of The incident described here occurred hugging the girl and then sat in silence during his 40th group session which for another twenty minutes. Finally, took place immediately following one of white someone else was talking, he his individual analytic hours. suddenly interjected with five minutes During the latter hour, the patient was remaining in the session: "That's what F hypnotized, for perhaps the thirtieth always do! I always wait until it is too time. Under hypnosis he regressed to late and then I get involved in things!" a level where at first he indicated that Since he had always refused to try he could not talk and, finally, with much any type of physical encounter he was sobbing and gasping, expressed, very then challenged to engage in a pushing dramatically, his feeling that he had contest with another group member killed his mother being born. Feeling ostensibly to prove that he had changed. that he was on the verge of some sort He accepted the challenge, with only of "breakthrough" a post-hypnotic sug- mild reluctance this time. He was show- gestion was made that, during the very ing considerable strength when he sud- next group session, he would express denly complained of a pain in his right very essential feelings which would lead shoulder muscle. I massaged the shoul- to some crucial insights for him. der while giving him strong suggestions During his year of group therapy he of relaxation and the pain disappeared had generally remained a silent ob- within one minute. He continued the server or had limited himself to detach- pushing and left the group session feel- ed, intellectualized comments on the ing very tired and elated. behavior of others. On this day he was, Two weeks later he announced to the typically, silent for forty-five minutes, group that he was working well at his and appeared to be occupied with his writing, that he was developing a whole-

* This paper was presented at a meeting of the Association for the Advancement of Psychoanalysis - December 3, 1970. Sidney Rosen, M.D., Assistant Clinical Professor Psychiatry, New York University Medical Center; Faculty, American Institute for Psychoanalysis. While the procedures described here depart from familiar psychoanalytic techniques, this paper is included in this journal in the interest of presenting diversified views. Ed.

90 SIDNEY ROSEN some interest in a girl he had been SOME INNOVATIVE HYPNOTIC dating for two months. He stated that he TECHNIQUES had decided that he would like to try working out his own situations without In the case history just outlined, the therapy. He terminated therapy that roles of suggestion or hypnosis are evening, with the approval of three apparently significant. Additional con- quarters of the people in the group and cepts about hypnosis will be discussed with my somewhat cautious approval as later. The assigning of physical tasks to well. Eight months later he returned to the patient was one of my first entr~es meet the group members after a session, into the area of what has become po- without prior notice and without con- pularized as encounter therapy. For sulting me. He wanted to tell them that several years, though, I had been less he was getting married in two weeks, concerned about the well known that he was publishing a great deal and dangers of assuming a more active role that he wanted to thank them for the in working with patients and more con- important role they had played in his cerned about those patients who seem- life. ed to continue on and on in so-called When this story is related to some therapy with very little changing, grow- analysts, their first response is: "He ing, self-realizing. probably dropped out of therapy, made In exploring other techniques to a flight into health perhaps to avoid supplement the relatively non-directive entering into a homosexual panic after ones of psychoanalysis, I had re-dis- you massaged his neck." Or they will covered my old interest in hypnosis, had attribute some other unwholesome mo- applied hypnosis as so-called hypno- tives to him. Perhaps it is a sign of our analysis and had experimented with own lack of belief in the possibilities of many of the imaginative techniques and growth and our over-commitment to a approaches which ingenious therapeu- skeptical, "scientific" approach that tic innovators such as Milton Erickson 1 when we are presented with apparent and Leuner have described. I had found, improvement -- a patient feels and acts with some patients, that "sensory hyp- cured of a serious difficulty such as noplasty" (Bernard Raginsky 2) helped. homosexuality -- our first professional This is the fantasy stimulating technique and emotional response tends to be in which a person, hypnotized or not, is "how is the patient fooling himself and given a piece of softened colored plas- us?" Yet for the purposes of this dis- ticene, often mixed with strong cheese cussion the focus is primarily on the or other odiferous substances. The pa- fact that this patient changed dramatic- tient is encouraged to "do with the clay ally after an apparently crucial session, whatever you like, let yourself go as that he was moved to some new activi- completely as possible." Often this ap- ties and attitudinal changes and that proach results in intense emotional ab- these changes were sustained and sub- reaction. In my hands, though, it did not sequently led to further change. What help sufficiently to warrant the cumber- were the pertinent factors which most some preparations of the materials that contributed to the changes -- are these was necessary. Sacerdote's technique factors seen in other forms of thera- of "Hallucinated Sensory Hypnoplasty," peutic intervention? Can they be used in which the person is hypnotized and in a more organized fashion and with given suggestions that he can see and greater awareness than previously em- feel the clay was just as helpful, much ployed? less messy and less time-consuming.

91 RECENT EXPERIENCES WITH GESTALT, ENCOUNTER AND HYPNOTIC TECHNIQUES I found myself searching, as I'm sure awareness and receptivity to hetero and some jaded therapists are searching, for auto-suggestions and that, when in this other effective ways of evoking emotio- state, a person can focus attention and nal responses in intellectualized pa- have his attention directed by the hyp- tients, for ways of helping obsessive, notist into uniquely vivid and subjective- alienated patients to have experiences ly "real'" forms of experiencing of with other ways of thinking, feeling and memories, of present perceptions and, acting. often, of objects suggested by the hyp- Leuner's "guided fantasies" and Sa- notist. I tend to favor Erickson's views

cerdote's "guided hypnotic dreams ''3 -- recognizing that the experimental provided refreshingly new experiences work of Barber and Orne showed that for some. Other patients responded well effects previously thought attainable to hypnotic age regression while still only after a hypnotic induction could be others were able to get in touch with obtained without such an induction in deep and meaningful feelings simply by some people. Recent work on "auto- being instructed to "feel your feelings" nomic conditioning" by Kamiya 6 and or to "let your feelings build up." These others in which subjects, without hyp- effects could be obtained with or with- notic induction, learn to control their out a formal hypnotic induction. own brainwaves, blood pressure, or hand temperature, indicate that con- cepts such as motivation, reinforcement RECENT EXPERIMENTS ON THE and Orne's "demand characteristics of NATURE OF HYPNOSIS the situation ''s are more significant in In the course of working with hypnosis determining a person's behavior, auto- again 1 discovered what experimenters nomic as well as voluntary, than whether such as T. X. Barber 4 and Martin Orne 5 or not he follows the criteria for deep have described in comparatively recent hypnosis on a scale for hypnotic work with hypnosis. They have found: susceptibility. If "imagining" a state of 1) that it is impossible to find any ob- health can clear up a skin rash or jective criteria for deciding when a plantar warts, let's learn how to develop person is hypnotized and that, 2) so far and intensify this imagining power. We as some of their sub}ects' ability to may call the procedure "hypnosis" or respond to suggestions was concerned, not according to our taste. it made no apparent difference whether or not they underwent any type of formal "PRESENTNESS" -- A LINK BETWEEN hypnotic induction. For example, in HYPNOSIS, HORNEY AND their experiments, control subjects tole- EXISTENTIALISM rate as much, or more pain, as "hypnotized" ones. Some patients demonstrate One of the best ways of evoking and more strength in the "waking" state intensifying vivid feelings and images is than in the "hypnotized" one. Barber that which was developed largely in has used his findings to question the work with hypnotic age regression and validity of the entire concept of hypnosis hypnotic "time progression". This is to and writes the word in quotations. ask the patient to describe events and Others, more in sympathy with the hyp- perceptions in the present tense -- with notic pioneer Milton Erickson, feel that directions such as "It is happening right there is a phenomenon which has tra- now." "You are three years old (or 90 ditionally been called a hypnotic years old). You feel and think and act at "trance", that this is a unique state of that age."

92 SIDNEY ROSEN

Fritz Perls, in devising techniques that after he is very much aware of his he calls "gimmicks" in his "Gestalt isolation, alienation, etc. Therapy", has carried this knowledge of The patient, for example, volunteers the importance of "presentness" from to sit in the "hot seat." He may say his earlier work with hypnosis. Perhaps "1 don't know what I want to work on." he was also influenced by his working Or "1 want to talk about a dream." What- in supervision with Karen Horney in ever his introduction, he is directed to Berlin. In any case, he not only empha- focus on where he is at the moment. sizes the "Here and Now, the What and This is done with questions such as: How," as Horney did, but insists that all "What are you feeling at this moment?" memories of the past and plans for the "Where are you experiencing your ner- future, dreams, fantasies, be expressed vousness? .... How?" If he says: "1 can't in the present tense, preferably acted, think of anything," it is suggested that with the patient playing all the roles, he rephrase this as "1 am blocking my one at a time. thinking or my feeJing." He is then asked to describe precisely how he is experiencing both the block and the blocking tendencies. If, when he is asked about GESTALT THERAPY -- his nervousness he says that he "cannot PRINCIPLES AND EXAMPLES feel anything, he is asked specifically What are some of the Gestalt Therapy "What do you feel in your taste? Your principles? In addition to its present- chest, your hands? Your testicles?" If centeredness 7 the most important of he says that he feels a shakiness in his these principles may be listed under fingers he is asked to show this -- to three headings as was done by Enright. 8 shake his fingers, even to exaggerate These are: the shaking until he can feel both his responsibility for shaking them and his 1. Concrete attention to detail rather concomitant emotions, thoughts and than abstract conceptualizing. fantasies. If he feels and expresses (Perls calls abstracting and intel- anger this is done only after the above lectualizing "intellectual garbage" process is experienced. The anger is not or even "elephant-shit") dissociated from him. In fact, it is very 2. Doing, with organismic involve- much connected with him. He may then ment, instead of talking about. be asked "Whom do you see (in your 3. Accepting responsibility for one's mind) when you feel this anger?" Often own behavior instead of denying, he will respond with "my father" or "my projecting, attributing, displacing, mother." Only then is he urged to act etc. out a dialogue with his father. He may pound on a pillow or choke the thera- In order to help actualize these prin- pist's arm or use whatever mode best ciples Perls has devised several tech- intensifies and expresses his actual niques which he frankly calls "gim- feeling at that moment. This approach is micks"? a far cry from a thoughtless, mechanical, In group workshops one of these gim- manufactured or non-directed encour- micks is his "hot seat" approach. In this agement of hostility expression as en- the patient is always guided towards couraged by some untrained "trainers." experiencing himself where he is first. At all times the feelings expressed are If hostility is then expressed or he is connected with the patient -- with his urged to touch someone, it is done only present and his past. The therapist in- RECENT EXPERIENCES WITH GESTALT, ENCOUNTER AND HYPNOTIC TECHNIQUES sists that the patient assume responsi- touch with that part too. He is encour- bility for his feelings, his words and his aged to go back and forth -- in each actions. case being asked "Did you hear your Later more complex and more con- voice?" After going to the other chair flicted feelings are expressed -- often he is asked "What is your response?" with the patient changing chairs or After a few shifts he often will say: "I'm assuming different postures in order to confused, which am I now? Top dog or more clearly experience them. In the underdog?" By this time the voices in classical "top dog"--"underdog" inner both chairs begin to sound almost alike. dialogue, for example, the patient will He may feel himself stuck at what Perls be instructed to sit in a higher chair calls an "impasse." He may be dis- when expressing the top dog part in missed then to resolve the impasse in himself -- the voice that says such his own time and place or he may be things as "you should .... who do you encouraged to continue the inner dia- think you are? .... you've never been any logue right there, trying different atti- good" -- the demanding, critical, judg- tudes in both positions. For example, if, ing voice -- Freud's superego, Horney's as top dog, he has been using his father "shoulds", Berne's "parent." He chan- as a model, speaking in his father's ges to a stool when expressing the voice and telling himself, as underdog, "underdog" -- the criticized part, the "you're no good and never will be" he child, the meek part, the hopeless part. may be asked at the point of impasse to Generally, he "writes his own dialogue," have his father, as top dog, try the line but if he has difficulty at times the thera- "1 really love you, my son." If he can say pist may suggest "lines." For example, this sincerely to his underdog, to him- let us assume that the patient is intel- self, and this is by no means easy, it lectualizing while playing "top dog." He means that he has already undergone is intellectually talking about the fact some shift in his self-acceptance. Say- that he cannot accept his indecisive- ing the words, without conviction is use- ness. The therapist may suggest, "Let less. I find that even a good actor can- me feed you a line -- try saying to meek not do this convincingly if he does not little indecisive John "1 hate you." Pa- feel it applying to himself. The therapist tient may venture cautiously starting in and group are very good judges of the a matter-of-fact voice to say the words. genuineness or phoniness of his emo- He is asked to repeat them -- louder tions although the patient is generally and louder-- until therapist, patient and asked "did you really mean that?" or group are convinced that this is a "do you take responsibility for holding genuine feeling and that the patient on to your anger?" or "did that sound owns it as his own. It may have been genuine to you?" brought out by borrowed words but if it does not fit it must be discarded. And matters are not left here. The patient is TAKING 6ACK EXTERNALIZATIONS not dismissed with only the satisfaction of being able to clearly express an We know the importance of taking back honest, strong feeling -- although, for our externalizations (Perls calls them many, this alone is no small accomplish- projections). But how to do this? Perls ment. He is asked to feel and then to has his subjects act them out -- "be describe the feelings of being the "top them." His theoretical basis for this is dog" hater. He then is asked to sit in the similar to that of Horney, i.e., that the "underdog" stool in order to get in characteristics in others which disturb

94 SIDNEY ROSEN us, or upon which we are focussed, are months after her marriage, one year be- often those which we are denying in our- fore beginning therapy. She has been selves and externalizing to them. To seen in group therapy for about one "complete our Gestalt" we must not year, having entered therapy to obtain only intellectually be able to say "yes, help with her unhappy marital situation I am really selfish, cruel, vain or what and her life-long morbid dependency. have you," but we must be able to feel Louise reports to the group that she has this and own it. For example, when been so depressed and withdrawn that Joan, a young physician, spent hour she has been unable, or unwilling, to after hour railing against her mother for leave her apartment for one month. She the latter's vanity, selfishness, frivolous- had started to come to the group ses- ness, and lack of respect for her, I could sion the previous week but had turned have talked in Horney's terms about her back after reaching my door fearing a claims on mother, the hurts to her pride "confrontation," she said. She tells the from mother's neglect, lack of apprecia- group that she feels she has "some- tion or criticisms of her. Instead, I sug- thing" which wants to come out but all gested to her "Be your mother, say for efforts to help her verbalize her feelings me, / am vain,, selfish and frivolous." lead to nothing except greater with- She said it, without much conviction. drawal from the group. In fact, after the I had her repeat it and she then admitted session had progressed for about one- that she really was vain, selfish, and half hour Louise is slumped on the frivolous. Characteristically, she quickly couch with a blank, far away expression followed this admission with "How can on her face. I stop it?" I remindered her that she had Sandra, after trying to draw her out been expressing envy for people such for about five minutes, wonders if the as Jacqueline Kennedy, whom she saw "confrontation" which Louise feared and as frivolous, vain and able to enjoy seek- wanted might not be a physical one. She ing pleasure, and that she might try, would like Louise to sit up straight since rather than getting rid of these inclina- this in itself might change her mood, tions in herself, to accept them, to relish Sandra feels. Louise's reaction is a them, indulge them by going to the helplessly stubborn one --"1 can't beauty parlor more often, for example. move." I suggest to Louise that she take The same approach was used with her responsibility and express directly what when she talked about her vindictive- she is doing. I also suggest that she say ness. She did not immediately stop her "1 won't" instead of "1 can't." She finally obsessive self-pitying reporting of hurts says, "1 won't move, fuck you." Sandra but this approach has given us a tool says that she will make Louise sit up. with which to shorten the amount of Louise, avoiding any 'cop out' on the time wasted in this way. Obviously this basis of her spasticity or presumed latter approach is an application of weakness from the multiple sclerosis, Wenkart's concept of "self-acceptance" says with some anger, "No, you won't." as well as Frankl's "paradoxical inten- Then, to the group's surprise, Louise tion." manages, for ten minutes to prevent Sandra from pulling her up. In the pro- PHYSICAL ENCOUNTERS cess Louise snarls and looks with hatred at Sandra as the latter uses all her Louise is an exceptionally beautiful strength in trying to straighten her up. young aspiring actress who discovered No words are spoken during this that she had multiple sclerosis three grappling encounter, except for the

95 RECENT EXPERIENCES WITH GESTALT, ENCOUNTER AND HYPNOTIC TECHNIQUES group members' surprised comments, "Winning was important," Louise said. such as "God, you're so strong Louise!" The groups' sanction and admiration for and "You come over as so helpless and her effort and strength was a supportive weak." element but her own feeling of the Finally Sandra conceded that Louise power of her stubbornness was un- had won and that she could not be doubtedly most important. I can think of straightened up. At this point, to her no other way she could have experienc- own surprise, Louise announced with ed this in a more direct and satisfying awe and amusement: "Now I feel like manner than through this physical con- sitting up straight!" She proceeded to frontation. do so, became lively, and exclaimed Obviously these confrontations are "1 had never believed in these physical not panaceas. Often they have little or encounters before, but the effect is no effect on participants -- except per- amazing!" Again the group members haps to pave the way for further inter- commented on her strength which she action. For example, Louise commented covers by withdrawing and appearing that a previous physical match ("pres- weak and helpless. She was emotion- sing," as described by Schutz) 12 had not ally involved during the rest of the ses- moved her at all. sion and left with an entirely different spirit than she had experienced for one month. Soon afterwards she felt the DREAM INTERPRETATION- courage to leave her cruel, detached GESTALT TECHNIQUES and impotent husband, feeling strong enough to manage on her own. Perls has taught us that it is important What are the elements that led to this to let patients play the objects in a effect? Some might say that the con- dream as well as the persons. Even if a cern and attention of the group and the patient says he had a dream but can't desire to please them by changing had remember it, he may be asked to "play led to Louise's moving from a helpless, the dream which you are blocking from sullen role to an active, lively one. But your memory." He may be encouraged the group had unsuccessfully tried all to have a dialogue with his dream and kinds of encouragement verbally, in- say lines such as "Dream, I won't let you cluding reassuring, analyzing her become into the front of my mind." Speak- havior ("in withdrawal you can keep ing as the elusive dream he may then your fantasy of being a great, undis- say something like 'Tm very vague and covered actress"), taunting her (in an slippery. I won't let you get hold of me." effort to make her angry) and sharing Of course the therapist will have the their experiences by telling her what patient repeat these words, listen to they were trying to express when they himself and apply them to his whole withdrew from contact with the world, being if he has not already done so. from competition, etc. None of these Often he will then remember a signific- approaches had begun to move Louise. ant dream. It was certainly not only the interest A sixty-year-old, self-effacing writer of the group that led to her break- who considered himself very youthful through. Perhaps it was some elemental and was concerned about his impotence contact with her own feelings and with and lack of interest in his writing, another human being. Sandra later de- dreamed of a narrow street with people scribed that fight as being like two little trying to get into an open window in girls having a stubborn battle of wills. order to look down on something. Asked

96 SIDNEY ROSEN to "be the street" he responded, "I'm me if she should tell all her feelings to very happy that all these curious, happy people. I suggest that she keep some in people are climbing all over me -- I am reserve. She agrees. She is beginning to a very old and festive street." When learn an inner control, to replace her asked if he heard himself, he recognized myriad of "shoulds." Incidentally, within immediately that he was feeling not only the two months following her experience that people were stepping all over him of playing dead, Gladys, for the first time but that he experienced in himself a in her adult life experienced and show- rather ripe joyousness. Although he had ed definite signs of being alive. She entered the session feeling very depres- showed facial animation, extreme rest- sed and heavy he left with a light feeling lessness and started to talk about and after experiencing these and other feel- experiment with being in her terms ings. Obviously a large element of sug- "naughty." For example, she dieted, gestion (hypnosis?) was instrumental in bought clothes, and she took a four day my asking him to focus on the festive trip to Copenhagen. feeling as well as the stepped-on feeling. In the above incident we see again In a group Gladys, a suicidal spinster the value of "acting out" a dream as of 46 years of age, states that she had well as the emotional contagion which dreamed she was being buried alive. is often seen in such dramatic enact- "1 put the first shovelfull of dirt into my ments. The careful suggestive control mouth then everybody heaped dirt on required of the therapist is also clearly me until I was buried." I suggest that demonstrated. she lie down in the middle of the floor and be dead. Then I suggest that shovel- HYPNOTIC EXPERIENCES IN full after shovelfull of dirt are being piled ENCOUNTER GROUPS on her. Another group member, Bea- trice, suddenly cries out: "1 feel the dirt Towards the end of a 24 hour marathon on my face -- in my nose! I can't Jane, who in ten years of therapy with breathe." two analysts had never enjoyed her I hold Beatrice as she cries and gasps sexuality, volunteers to sit in the "hot repeating in a frightened voice, "t can't seat." Suddenly she turns toward me breathe!" I ask her to "tell me what's and begins to punch viciously at the stopping you?" She chokes out, "all the pillow which I am holding in my lap. She phoniness, all those years of holding in screams out "You goddam bastard! You my feelings, never saying what I feel." cock-sucking son of a bitch!!" and hits I suggest "Say one thing you feel right even harder, so hard that as I hold the now and you'll be able to breathe." "All pillow in front of me she almost knocks I can think is'fuck'. .... Say it," I demand. my chair over. I ask her "What are you "Fuck." "Again." "Fuck" ("louder") hitting, Jane? .... My father's penis!" she Fuck, fuck, fuck!!" she screams. "I'm yells. I let her continue hitting and not like these people! I don't feel like shouting in a frenzy, for about five them! They all hate their parents. I like minutes more. my mother and father!" ("You don't have I suggest to her that she act out a to be like them. You have your own dialogue with her father, playing both feelings. It's alright not to hate your parts herself. She explains that he would parents," I comment.) Her breathing be- speak in Yiddish, but she does not speak comes deeper and I say "That's it, let it Yiddish. I tell her, "1 will translate." For in and out, enjoy the air." She becomes her father, she then says "1 am sorry" calm and returns to her seat. She asks ("enschuldig mir," I translate). "I'm in

97 RECENT EXPERIENCES WITH GESTALT, ENCOUNTERAND HYPNOTICTECHNIQUES pain." ("es tut mir vey"). For herself she nagogic trance with positive auditory screams her resentment towards him. and visual hallucinations. 11 I then suggest "it's time, Jane, that you We see that, under certain conditions forgive your father. He's an old man now the presence of an expectant audi- and you are grown up." I hand her the ence, heightened emotional tension, the pillow. "Here, hold him and talk to him. verbal expression of certain emotion- You are the strong one now." She rocks laden feelings and attitudes in the the pillow, cries and talks to her father. present tense, the presence of a trusted "Does he hear you?" I ask. "Yes." Sud- leader or guide -- a person is more denly Jane turns to me "Let me hold prone to wipe out the boundary between your head." I do so and she lays my an "as if" perceiving and a "real" one. head against her breast. She cries out, For example, by talking to her father, "Daddy, feel my breasts! I'm a grown Jane soon felt and perceived that he woman! I'm going to go out and find a "really" was there. Now, in the example man like you.., and rm GOING TO given, Jane was able, after 23 hours in FUCK HIM !!" the marathon, to eliminate this bound- I suggest that she express her feel- ary by saying the words and throwing ings toward some man in the audience. herself into the role of a child. In other She assumes a patrician pose and after cases the addition of more conventional a dramatic silence of two minutes com- "hypnotic" suggestions or "hypnotic" mands "Donald, come here!" Donald, induction might have made the elimina- who later admitted that he was quaking tion of the boundary more feasible or in his boots after seeing her violent dis- more acceptable to certain patients. play, approaches her cautiously. "Hold Barber's 4 work, in trying to define what me, Donald," she commands. "Protect conditions are necessary to attain this me!" Donald embraces her while many state of mind, is potentially helpful, al- members in the audience weep. though experienced clinicians develop Subsequent to this marathon she was a "feel" for the types of settings and able in weekly group sessions to dra- suggestions, of time of voice to use in matically act out sexual and other con- "setting the scene" and eliciting the flicts, employing role-playing similar to desired behavior. Sometimes their di- that which I have described above. She rections are labelled as "hypnotic in- reported enjoyable sexual experiences, ductions." At other times the patient, was able to sustain a relationship with mostly by himself, will enter into a re- one man for a year (for the first time in vivification of old experiences or an in- her life) and then married him. creased awareness of body sensations. Now, this type of drama occurs very The latter behavior may be in response often in encounter and Gestalt groups. to the conditions I have outlined or to It is brought out without any formal hyp- pre-existing conditions -- expectations notic induction and with minimal sug- and auto-suggestions of the patient gestions of any kind. Yet when the pa- himself. tient is told "talk to your father," she INFLUENCING PATIENTS- talks as if he were really there. When INEVITABLE AND HELPFUL asked "do you see him?" she will an- swer in the affirmative. Thus hallucinat- Whether the final behavior of the patient ory behavior is demonstrated. If this is labelled as being "in hypnosis" or not were seen after a hypnotic induction the is rather unimportant. What is important patient would be judged to be in a state is having the greatest possible aware- of about Grade 10 hypnosis -- a hyp- ness, and thus control of what we as

98 SIDNEY ROSEN therapists are contributing to the situa- being constructively critical of her tion. In the analytic situation, it is only mother. At this point, I suggested that a rare hold-out who will claim that we she criticize the women in the group do not influence our patients. When we again and she was able to do it in a comment, we influence; when we remain manner which enabled them to listen silent, we influence; when we are with without retaliatory viciousness of their the patient in a Park Avenue office, we own. influence. Perhaps it is only more ob- Whether or not we throw out the word vious to note that when we swim with "hypnosis" because of the many mysti- him in a hot spring pool in the nude, we cal and charlatan associations of the also influence. word, is not, it seems to me, nearly so As clinician and as scientist it be- important as whether or not we become hooves us to examine and study the more aware of the many factors which nature of this influence, to direct it in influence our patients and our own more effective, most helpful and most responses and behavior, including our efficient directions. For example, we can taking responsibility for and accepting help patients to learn inner control of the fact that we influence our patients, emotions by encouraging them to ex- hopefully for the good. The concept of perience and express their feelings and Svengalilike influence has long been thoughts in the most open, most intense discarded in hypnosis and the illusion manner possible. In this way they will that psychoanalysis can be value-free feel their own organismic limitations. has been quite thoroughly destroyed in Those who fear losing control will find recent years, partly due to Horney's that they do not fall apart or destroy pioneer thinking as expressed in her others when they express the full extent chapter "A Morality of Evolution. TM of their vindictiveness or rage in a the- EXPERIENCE -- NOT TALKING ABOUT rapeutic setting. Often it is more possible for them to do this first by role We have techniques. We have goals. playing, then by relating to the actual Perls and others have spelled out, in persons in the therapy group. Only after their development of Gestalt therapy, they have had the experience of letting many techniques which we can relate go can they be encouraged to control directly to our goals, without needing to their feelings and words or to direct rely on rather vague general constructs them in an effective way, towards actual such as "self-realization" even though people such as those in their therapy these may still be useful in retroactively group. After a person has acted out his evaluating the longer range picture. For protective feelings towards his mother, example, in groups, if a patient has ex- for example, he may be asked to experienced himself differently he shows press the same feeling towards some of it immediately, in his voice, in the way the women in the group. A woman who his face clears, in his perceptions of was furious with the other women in her others in the group. He may be directed, group, and subsequently evoked hostile and often is, to look at the others and responses from them, was encouraged asked "Do you see them?" When the to express her fury towards her mother veil of his confusion and alienation is first. She did this initially in an uncon- drawn aside he is often surprised at the trolled, vicious manner. After playing vividness with which he sees people and both her own role and that of her objects. mother, the degree of viciousness sub- As an example of direct experiencing, sided and she was able to fantasize not talking about, a patient who says

99 RECENT EXPERIENCES WITH GESTALT, ENCOUNTER AND HYPNOTIC TECHNIQUES

that he has trouble expressing hostility "You are the doctor and I'd like you to may be asked to say something hostile tell me whether you can help me" I may to each member in a group, or to the tell him my feelings of hopefulness or therapist in an individual session. He lack of it based on my response to him, and the therapist and others, if present, my past experience and so on, and then can directly experience his difficulty in I will still leave it up to him to decide doing this, and can also experience with whether he wants to invest the time and appropriate focussing on patient's voice, money for another session. I may, on posture, response of others, etc. what the other hand, suggest that he play are the factors involved in his difficulty. Dr. Rosen and, as me, respond to his Finally, he may be urged to try again questions. using his newly gained awareness. He For example, Daniel, a rather para- may observe, when asked "What are noid 40 year old man, spent most of his your hands saying as they clasp one first session telling me how stupid, rigid another?" that they are holding one or self-seeking all his other therapists another for reassurance. When asked to had been and concluded with his con- see what he feels when he holds them sidered and frank opinion that there apart he may experience his fear more really was no therapy that could help intensely. He may be directed to try him with his problems of indecisiveness, saying to someone "I'm afraid and also helpless rage at his wife and multiple furious at you for..." If the timing is somatic preoccupations. He had come good and he feels safe he may then to me for hypnotic therapy after hearing have a different experience in expres- me discuss hypnosis on a television isng his anger, perhaps more clearly program. In this first session, since this and forcefully than ever before in his was what he had come for, I suggested life. that we test his response to hypnosis. Since I perceived that he was obviously PATIENTS' RESPONSIBILITIES AND very much afraid of being influenced by INVOLVEMENT IN PLANNING anyone I told him this and suggested TREATMENT that I would show him how I hypnotize myself and that he could try the same Since one of the prime goals in my method with himself if he so chose. He existentially-rooted therapy, and Gestalt discovered that, after concentrating on therapy in particular, is the insistence a button on my couch, maintaining the that the patient assume responsibility image in his mind and letting his eyes for himself as much as possible, it is close, he felt that he was in a sort of natural that I carry this attitude into trance. But the fact that astounded both asking the patient, as soon as possible, of us was that in this state, no matter to decide important questions with what we called it, he was a different regard to his therapy. person. He focussed on himself, his After a first consultation session, I fantasies, his memories, his fears, in- will generally ask a patient whether he stead of me, his wife, career decisions found the session helpful, whether he is and other outside factors. From a bitter more or less comfortable at the end paranoid with a forced supercilious than at the beginning; whether he feels smile he changed to a serious, thought- that he would like one or more sessions ful, very sensitive person -- rather ob- further before trying to decide whether jective about himself and quite poetic he finds our working together helpful. If in his choice of fantasies. he counters with the non-responsible At the end of the session after emerg-

100 SIDNEY ROSEN

ing from his "trance" he challenged me and rightly so, with the danger of en- in his usual guarded manner, asking if I couraging highly emotional people to thought I could help him. I simply re- express all of their suppressed and re- flected my observations on the differ- pressed rage, despair, or clinging needs ences I have noted above. I told him that in a concentrated manner and in a com- with his long history of refractoriness to paratively brief period of time. It is in all treatments, I had strong doubts about precisely this area where our experience his being able to make significant with hypnosis is invaluable. We have changes and yet that I was also im- learned, in working with hypnotized pressed by his persistence in seeking persons that a simple suggestion will this type of help. I told him that I liked often stop an emotional outburst just as working with him when he was in the quickly as it may start one. I will give an self-hypnotized state and he agreed example. Seymour, a 55 year old anxious that he was fascinated also to find that hypochondriacal married man, with he was able to bring out such fantasy married children, had been in therapy resources in himself. I cut my usual fee with various therapists for over 15 years, to accomodate his finances and he de- with no improvement in his chronic clared that he wanted to come once a anxiety and somatic preoccupation. He week. Whenever he would ask me, as he had, in his fourth group session with me, had his previous therapists, whether I spent half an hour and had exhausted thought he was getting anything out of himself, shouting hoarsely at his long therapy, I would tell him my observa- dead parents. He is short of breath, tions, usually emphasizing the negative feeling weak, perspiring profusely. The slightly. He would then assure me that group, as an audience, have been awed "somehow" he felt he was making some and impressed by the strength of the progress. His wife's therapist, he finally emotion and the voice coming from this told me, had noted a big improvement man who they had originally perceived in him. as a snivelling coward. I recall that after his last outburst of anger in the group DANGERS OF ENCOUNTER GROUPS he had gone to his father's grave, telling Any technique, used mechanically and father that he wanted to pee on him. At without a place in some broader con- the next group session he had reported ceptions of aims, goals and understand- being subsequently very depressed for ing of the person's character structure, three days. He doubted the therapeutic can be ineffective at best and growth value of this suffering and threatened to blocking at worst. The danger of "ad- leave therapy. I decide to help him diction" to dramatic encounter meetings towards some degree of closure before exists with some patients. However, he leaves my office, this time. First, I some analysts -- frightened or shocked suggest that he play his father, after he by some of the more dramatic and has finished expressing his remaining bizarre reports emanating from the anger at his fother. Later I highlight both thousands of "encounter groups," pro- his father's and his own areas of fessional and amateur, may be dis- strength. Finally, I encourage him to inclined to utilize some of the gimmicks express his strength with members of -- even in the context of an ongoing the group. In "Gestalt" terms I am help- relationship -- with the background of ing him "complete the Gestalt" by own- their own professional experience and ing and identifying with both the "father" ethical goals to protect the patients. and the "child" in himself. In hypnotic Some analysts have been concerned, terms I am, indirectly, giving him posi-

101 RECENT EXPERIENCES WITH GESTALT, ENCOUNTER AND HYPNOTIC TECHNIQUES tive, reassuring suggestions to counter- With the recognition of these factors, act his self hate. This time there is no the technical problems in therapy could reactive guilt, but instead he follows the be seen as revolving around first finding session with a period of increased more effective means of enhancing in- energy and productivity. volvement while the theoretical problems evolve around determining which CONCLUSION values and goals are best aimed at and encouraged. With regard to the latter, I would like to propose the following the questions must constantly be asked basic principles about therapy. by therapist and patient: "What am I 1. The therapist must conduct the being cured to as well as what am I therapy or else no therapy takes being cured of?" place. As Horney and others have Karen Horney's holistic theory of psy- put it, patients come into therapy choanalysis, with its clarification of to enhance, repair and improve character defenses such as intellectual- their neuroses. It is our job to re- izing and externalizing, and with its direct them towards growth and integrated emphasis on factors such as self-realization. alienation, neurotic pride and "shoulds" 2. Patients are most open to thera- provides me with answers to the latter peutic changes in an atmosphere question. The existentialists' highlight- of strong involvement -- involve- ing of the importance of choice, aware- ment of the patient with his own ness, responsibility, wholeness, process feelings and thoughts, involvement and risking, point up directions for between patient and therapist. In goals. Fritz Perls provides invaluable groups, this intense involvement aids in solving the technical problems. may occur between patients. Pa- He suggests many new ways of "being tients move best when they are with the patient" and thus following moved. I would include here the Horney's injunction for conducting an experience of feeling "intellectual- analysis. ly" stimulated. BIBLIOGRAPHY 1. Haley, J. Advanced techniques of hyp- ness. Charles T. Tart (ed.) New York: nosis and therapy. Selected papers of John Wiley & Sons, 1969, pg. 507. Milton H. Erickson. New York: Grune & 7. Naranjo, C. in Gestalt therapy now. Joen Stratton, 1967. Fagan and Irma Lee Shepherd (eds.). 2. Raginsky, B. B., Sensory hypnoplasty Science and Behavior Books. Palo Alto, with case illustrations, Int. J. Clin. Calif., 1970, pp. 47-69. Exper. Hypnosis. 10: 205-219. (Oct.) 8. Enright, J. B. ibid p. 271. 1962. 9. Perls, F. S., Gestalt therapy verbatim. 3. Sacerdote, P., Therapeutic use of in- Lafayette, Calif.: Real People Press, duced dreams. Amer. J. Hypnosis. 10: 1969. 1-9 (July) 1967. 10. Perls, F. S., Gestalt therapy now. pp. 9- 4. Barber, T. X., Hypnosis: A scientific ap- 10, 35, 36. proach. New York: Van Nostrand Rein- 11. Hilgard, E. R., Hypnotic susceptibility. hold Company, 1969. New York: Harcourt, Brace & World, 5. Orne, M. T., The nature of hypnosis: 1965. Artifact and essence. J. Abnorm. Soc. 12. Shutz, W., Joy. New York: Grove, 1969. Psychol. 58: 277-299. 13. Horney, K., Neurosis and human growth, 6. Kamiya, J., Altered states of conscious- New York: Norton. Reprint request to 221 East 50 Street, New York, N.Y. 10022.

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