Chapter VII

Posthypnotic Suggestions

ON, JE of the greatest values found in hypnosis is the use

of posthypnotic suggestions. For those who may not be too familiar with the terminology of hypnosis, a posthypnotic suggestion is one which is given to the subject while in the hypnotic state but which is to be carried out by the patient after emerging again into his usual state. Sometimes suggestions given during hypnosis will carry over into the usual state of the subject and, therefore, if the practitioner desires the suggestions to be effective only in the hypnotic state he must be certain to terminate them. Usually, however, when it is desired that the suggestion operate afterwards, instructions to that effect are given as a part of it. These suggestions may involve practically any aspect of the patient's life, including not only his overt behavior but also his beliefs and attitudes. This does not mean that solely by suggestion one can change a patient's whole plan of life over night. Here again hypnotic suggestion is to be looked upon simply as an adjunct to other methods, including nonhypnotic suggestions which are used to cause an indivdual to be better adjusted or to aid him in overcoming some handicap which he suffers. Here, merely as illustrations, are a few examples of the
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use of posthypnotic suggestion. The uses of this device are legion and, therefore, our endeavor is to give the principles involved and to rely upon the ingenuity of the reader to see where this kind of suggestion could be useful and how to phrase the suggestions. Not long ago a young man came to my office. He had been referred there because he became extremely self-conscious when giving his piano recitals. He is apparently quite a gifted musician and he hopes to make music his career. But his inability to conquer his stage fright was very discouraging to him. He was quickly put into a light state of hypnosis and suggestions of this nature were given. "You have practiced your recital material thoroughly. You realize that you have complete command of the mechanics of the various pieces which you are going to play; therefore, there is no reason for you to be disturbed by your appearance before the audience." (All these statements were true and the individual would have admitted such to be the case. The fact remains, however, that he was nervous when he played; therefore, it was necessary to go further with the suggestions.) "Now, because you have complete mastery of the mechanics of the music which you are going to play you will become fully occupied during the recital with getting the meaning of the music over to the audience. You will make them feel the emotion of the music. They will live the music with you." Suggestions of this sort were repeated with variations several times. The purpose of the first set of suggestions are to give the

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individual a sense of conviction of the truth of conditions which he would have readily agreed to on a verbal level but about which, nevertheless, he might feel some doubt. We have all had the experience of acquiescing to some statement because it is logically and circumstantially correct but about which we still have some mental reservations. We know that it must be true and yet we cannot fully accept it. It is characteristic of a successful posthypnotic suggestion that it is accepted with complete conviction by the subject. In experimental situations the subject can be caused to accept with conviction propositions which are most obviously incorrect. The purpose of the second set of suggestions was to make a logical and adequate substitution for the attention which the subject was paying to himself when he played. The idea was to get the subject so wrapped up in what he was doing that he had no time to be self-conscious. If one could do this, then the situation of which the subject complains would be conquered, at least for the time being. In a case of this kind the attempt is made to change the attitudes and feelings of the subject not by direct suggestion but by indirection. If once the musician can get through a recital without stage fright, then that fact itself will bolster his selfconfidence and he is more likely to succeed the next time even though the direct effect of the suggestions may have largely dissipated with time. In this case the subject was asked to return again the day before his recital and much the same routine was re-

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peated. After the recital he returned to the office to say that he had gone through it without nervousness and he was feeling very set-up about it. It had been made clear to him previously that the aim was to show him that he could go through a recital without fright and that with this knowledge he would subsequently be able to handle the situation adequately. We hope that this will be the case as we must be careful not to allow the individual to rely on hypnotic suggestion as a sort of opiate he reverts to in a crisis. Rather, we wish the individual to secure control over his own behavior and to become self-dependent. The effect of the motivational factor must not be overlooked in the application of posthypnotic suggestions. In the case just mentioned it seemed quite obvious that the individual was highly motivated to overcome his difficulty. But this is not always true. One who uses hypnosis will frequently be approached by persons who say that they wish to stop smoking. A little questioning will frequently make it fairly clear that the verbalized desire to stop is not founded on any very compelling motivation. The individual really does not wish to stop but is finding some satisfaction in going through the motions of quitting. The doctor has told him that he should stop or it is costing him too much money or he just feels on general principles that he shouldn't smoke so much. In other words, for one reason or another he has a bit of a guilt complex about smoking and the effort which he is making to stop quiets the guilt feeling to some extent.

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In a situation of this sort the chances are that a posthypnotic suggestion against smoking will have little effect unless the individual can be put into a very deep state. A hypnotic suggestion properly given in this condition frequently has a quality of almost irresistible compulsion about it. For instance, the individual could be given the suggestion that hereafter the cigarette will have an extremely bad and obnoxious taste to him. This idea can be amplified with descriptions of the nature of the taste as if, for example, he had put some specified foul substance into his mouth. The likelihood is that if the individual is in the somnambulistic state this suggestion will operate and cause him to be unhappy, although it may stop his smoking. It is questionable whether one should make use of these compulsive suggestions except as a last resort. In this case, for example, if the individual were really doing serious harm to his health by the smoking, the ends may justify the means. Barring such circumstances as these it is obvious that one runs the risk of setting up in the individual a powerful conflict between his desire to smoke and the hallucinated gustatory experience. Such a conflict may cause some difficulties. If by verdict of his physician the person is really doing serious harm to himself by smoking the better procedure would be to try to produce in him a genuine motivation to stop the habit. This could be done by appealing through hypnotic suggestion to some of his strong drives. For example, suggestions to him of the consequences for his

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family should he continue to injure his health. The technique is to build a motivation in him which would lead logically to the cessation of the habit father than to cause a cessation by an illogical condition such as a bad taste in the mouth. We must make every effort not to disturb the integration of the patient. The clinician will need to use a high level of skill to determine what the dominant motives of the individual are and to work these into his suggestions about smoking. Suppose, on the other hand, that the individual comes in with a really strong motivation to stop the habit. Then a little hypnotic suggestion of a rather direct nature will likely be of great help to him. Let us take the case in which the subject has a girl friend with whom he is much in love. She has told him that he must stop smoking or else. This reason for stopping may not seem very logical to the hypnotist but never mind about that. Pleasing the girl friend is a much more powerful and appealing motive than are the statements which the physician makes about health. Some of the habits which the physician or clinical psychologist is called upon to treat are usually considered to be of a neurotic nature. Examples would be enuresis and nail-biting. It is assumed that the neurotic habits are simply symptoms of some underlying difficulty. Unless strong circumstances dictate otherwise, the use of hypnosis in these cases would not involve posthypnotic suggestions to counter the habit but rather the effort would be made

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to get at the cause of the difficulty. Hypnosis may be invoked in this effort but that is another story about which we are not at the moment concerned. Sometimes these neurotic habits become a segment of a vicious circle in that they give rise to new psychological difficulties while the original difficulty which initiated the habit has disappeared. Under such circumstances a direct suggestion countering the habit may break the circle and the whole matter will clear up. It is for the psychotherapist to decide what the situation is in the case of neurotic habits and to act accordingly. Since this book is concerned only with the applications of hypnosis it is outside our province to discuss psychotherapy in general. There are conditions that are not usually assumed to be of neurotic origin and which are not habits but for which hypnotic suggestion proves very effective. Two examples of these are functional hyperemesis gravidarum and functional dysmenorrhea. One may give quite direct counter suggestions to these conditions but here also I have found it best to provide the patient with a reasonable basis for the counter suggestion, and also a method of self-control. For example, in the hyperemesis the hypnotic suggestion would go something like this: "The doctor has given you a thorough examination and he finds no physiological reason for your morning sickness. He feels that it is just because you are a little tired and it is a bit difficult to become accustomed to your pregnancy. Therefore, your sickness will quickly disappear. If after our period of relaxation today you should at any time feel a little nauseated just

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sit down for a moment and the feeling will quickly disappear." These suggestions are repeated with variations several times and the patient is allowed to rest in the hypnotic state for about 30 minutes. Usually one treatment of this kind is sufficient even though the subject is in a fairly light state. Essentially the same suggestions with the proper changes can be given for the functional dysmenorrhea cases. No attempt is made here to enumerate all of the conditions in which posthypnotic suggestion will be found useful. Perhaps a general statement might be that all functional difficulties which are not of a psychotic nature may be amenable to hypnotic suggestion although as indicated above some of these conditions are quite definitely symptoms of a deeper underlying difficulty which the psychotherapist would ordinarily try to determine and solve. In all cases, however, the therapist will need to use extreme care in the formulation of the suggestions which he gives to the patient. Suggestions, like all other methods, will sometimes fail even when the circumstances seem to be optimal. I feel that one of the most important causes of this is the failure to tap a sufficiently strong motive in support of the suggested change in the individual. No standard set of instructions can be given for the use of posthypnotic suggestion in psychotherapy because each case is different in many respects. On the other hand, in dentistry it is possible to enumerate a fairly standard list of suggestions which will be useful to the dentist. Such

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a list is given here but the dentist must use his own ingenuity in devising his own formulation of the suggestions. If he tries to learn some set discourse it will inevitably sound stiff and stilted and will lose some of its effectiveness.
POSTHYPNOTIC SUGGESTIONS OF USE TO DENTISTS

(1) Analgesia when it is felt that this is desirable. This could be given and should be effective even if novocaine was used during the surgery. This suggestion should have a terminus, e.g., this analgesia is to last for 24 hours. (2) Suggestion that a denture will feel comfortable and give great satisfaction to the patient. This would seem not to violate any ethical considerations provided the dentist is skilled in the fitting of dentures. It is assumed that if such is the case most of the complaints from patients arise from the fact that they are unaccustomed to the denture and all that is necessary is for them to wear it for a while to get used to it. Complaints of this nature should be largely eliminated by the proper posthypnotic suggestion. (3) Suggestion that hereafter the patient will not allow himself to be put into the hypnotic state except for medical or dental treatment and only by a person qualified to give such treatment or under the direction of such a person. Probably few patients would be tempted to allow themselves to be put into a hypnotic state for entertainment

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or other undesirable reasons but it is just as well to give the instruction indicated above. (4) If it is known that the patient must return for another appointment and if the date can be agreed upon beforehand, it would be possible to give a posthypnotic suggestion to the effect that the patient will be sure to keep this appointment. In this way, broken appointments could be reduced in number. No doubt there are certain patients more prone to break appointments than others. The dentist might confine suggestions of this kind to that type of patient. (5) Suggestions designed to relieve the apprehension and anxiety of the patient in regard to dental work, e.g., that dental work can be quite without discomfort if done correctly, etc. "You will look forward to your next appointment with pleasure now that you know how comfortable you can be in the dental chair." (6) Suggestions designed to foster correct care of the teeth, e.g., frequent check-ups in order to catch trouble at an early stage, proper brushing of teeth, etc. Suggestions of this sort are constantly given by dentists and they will be more effective if given during the hypnotic state as well as in the waking state. (7) Suggestion that after this the patient will go into the relaxed hypnotic state very quickly in the dental chair. The dentist may specify that he will give the patient a signal or he may go quickly through the same procedure he used in producing the hypnosis in the first place.

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(8) Suggestions that when the patient awakens he will feel rested and refreshed, fully awake, cheerful and happy, that a session in the dental chair is, under these conditions, restful and relaxing; that this state of relaxation called hypnosis is a very pleasant state to be in. (9) Suggestions limiting the use of sweets, especially between meals if it appears that the patient has undue caries because of eating candy, drinking soft drinks, etc. (10) Suggestions to counter the exploration of a new filling by the tongue in cases where it is felt that the patient might irritate the tongue by this activity. (11) If the dentist is using a card recall system, a posthypnotic suggestion as follows could be given: "When you receive my card months from now you will recall the comfortable experience you have just had and desire another appointment for an inspection of your teeth." (12) As a routine procedure give a posthypnotic suggestion about night-time sleep: "Tonight when you go to bed you will have the best sleep of your life. In the morning you will awaken feeling wonderful because you have had such a good sleep." Another very useful function for hypnosis is in obstetrics. Here the method is used in two ways: (1) as a method of teaching relaxation and giving the subject control so that she may relax when the occasion demands; and, (2) giving counter suggestions to the fears and superstitions which many women have about childbirth. The control over relaxation is given to the woman by means of posthypnotic suggestions although she does not

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realize this. After putting the woman into a hypnotic state, it is pointed out to her how extremely relaxed she is. She is then told that she can relax herself like this without the need of someone standing at her side talking to her. It is explained to her that what we are using is simply suggestion and that she can give herself suggestions just as well if not better than someone else can give them to her. We then give her the instructions for what is essentially autohypnosis produced through posthypnotic suggestion. The instructions go something like this: "In a few moments I will count to three and on the count of three your eyes will open but you will stay relaxed. Then after your eyes open you may slowly close the fingers of the right hand and as you do so think to yourself that your eyelids are getting heavy and your muscles are relaxing more and more. You will think to yourself 'as my fingers close my eyelids are getting heavier and my muscles are becoming more and more relaxed'; then you will find that your eyelids do become heavy and they will close. It will be very pleasant to have your eyelids closed. And your muscles will become very relaxed. You see that we wish to give you control so that when you come to your labor you can become completely relaxed and that will make your labor so much faster and easier for both you and the baby." This suggestion is repeated several times with the same ideas expressed slightly differently. And then we say, "Now we will practice this. On the count of three your

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eyes will open and we will practice closing the fingers and going back to our state of extreme relaxation." This set of suggestions will almost invariably work even though the subject is in a very light hypnotic condition. Note that the effect of the suggestion is to keep the patient in a relaxed state even with her eyes open. This makes it easier for her to get her eyes closed through auto-suggestion. After it has been practiced this way several times the subject is given a suggestion that after her eyes are open she will move around in the chair a little so as to get a little tension back in the muscles in order that she can practice getting it out. Suggestions are also given to her that she will practice this at home, especially when she goes to bed in the evening. These patients are usually seen about four times for a half hour each before their confinement and each time this self-relaxation is practiced. The aim is obviously to get the patient to the place that when she goes into labor she can stay relaxed and without apprehension. Obstetricians universally agree that this makes for an easier labor. No promise of a completely painless labor is given. In fact, the term pain is not used at all. Rather, through suggestion we try to get the woman's attention fixated on the discomfort which is associated with any kind of hard work. We point out that there is no normal way of escaping this hard work in childbirth. It takes strong muscular contractions to help the

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baby pass through the birth canal and that we must expect this hard work but that it is no different from any other hard work which she might do. The effort here is to get the woman to interpret the sensations which she will certainly have during labor in terms of hard work rather than pain. There isn't much question but that a good deal of the "pain" of childbirth is simply a misinterpretation of the unusual and intense sensations resulting from the uterine contractions. Not infrequently "pain" is where we find it. It is a psychological phenomenon and may have little or no physiological basis. There is, of course, no inclination to deny that there is physiological pain under some conditions. The use of posthypnotic suggestions is one of the most valuable techniques connected with hypnosis. Fortunately, posthypnotic suggestions which are to the benefit of the patient and which are supported with strong motivation will be effective even though the individual has not been in a deep hypnotic state. The advantage of deep hypnosis is that the individual will almost certainly have posthypnotic amnesia for the suggestions which are given to him and will, therefore, not be able to set up much resistance to carrying them out. The suggestion will tend to produce compulsive behavior in the individual. He will not understand why he is acting as he is and if questioned will probably produce a rationalization for his activity. As we have already indicated, there is serious question whether a procedure of this sort may

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not cause more harm than good. In some cases it would no doubt be desirable to have the suggestion carried out via compulsive behavior. For example, in obstetrics it would be a desirable state of affairs if we could have every patient go into somnambulistic state and in that condition receive suggestions of relaxation and anesthesia which she would compulsively carry out during parturition. Under the circumstances attendant upon birth such compulsiveness could do no harm. In addition, it is almost inconceivable that the patient would have any motivation to behave otherwise and, therefore, there would be no opportunity to establish a conflict situation. Suppose, on the other hand, that a physician in attempting to cure enuresis should be so unwise as to give a somnambulistic patient the suggestion that he should urinate every evening at 10 o'clock, and let us suppose that the patient compulsively attempts to carry this out without knowledge of why he should be seized with this impulse at 10 o'clock each evening. It does not require any great amount of imagination to conceive of the difficulties such a situation might occasion in the patient. These difficulties would not only be of a circumstantial nature but also psychological. It is certainly not wise to establish in any subject behavior the cause of which is hidden from him. We have enough of such behavior arising under ordinary circumstances without adding to it artificially. The essence of psychoanalytic treatment is to help the individual to get insight into the causation of his behavior.

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When we are using these compulsive suggestions we must almost invariably use some sort of a signal to set them off. The signal may be the time of day such as 10 o'clock used in the example above or it may be some other circumstance such as the onset of labor as in obstetrics. Or it may be some signal given by the hypnotist if the behavior is to be carried out in his presence. If the suggestion is to be a longterm one and the suggested behavior is to be repeated it is not easy to find a suitable signal because one cannot foresee all the circumstances which will surround the subject. For example, a student comes with the complaint that he has trouble settling down to study and he would like some hypnotic suggestions to aid him. Let us assume that we are satisfied of the genuineness of the motivation. We ask that student what his study period is and he says from 8 to 10 in the evening during the weekdays. We hypnotize him and give him the suggestion that he will concentrate and pay strict attention to his study during this period each evening except Sunday. (The suggestion will not be made so directly as that but there is no need to go into details for this purpose.) Now, there are going to be evenings when circumstances will dictate that he should do something else at the particular time indicated. Perhaps a good play comes to town and he would like to go to the theatre. It is not likely nor desirable that the suggestion should be so powerful that he would study from 8 to 10 in spite of everything. Consequently, he goes to the theatre but

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while there he feels uneasy. He should be studying. He is restless and doesn't really enjoy the play. This is an unfortunate situation but also, unfortunately, one could hardly give the suggestion that study should be carried on every evening from 8 to 10 except, except except. How can one foresee how many exceptions to put in and besides the suggestion would soon become unmanageable. This is an example of a situation in which the use of posthypnotic suggestion could be very effective and yet is exceedingly difficult to manipulate. In a case of this kind it seems undesirable to give a specific mechanical suggestion like the one used. Rather, by the use of suggestion one may attempt to strengthen the already existent motivation of the individual and then give him a suggestion which is dependent upon his own behavior for its cue. For instance, as soon as you sit down to your desk to study you will find it easy to concentrate, nothing will bother you, etc. It is also desirable in a case of this kind to suggest that no other activity be carried on at the desk. That is, if he wishes to write a social letter it should be done some place else. The purpose of this is to get the desk situation connected with study and nothing else. We cannot expect the suggestion to be effective indefinitely and, therefore, we must endeavor to form a habit in the individual which will carry on after the suggestion has lost its effectiveness. If we can get the desk situation habitually connected with study activity, then when the individual sits down at the desk he will automatically start studying. On the other hand, if the desk

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situation has been connected with a number of different activities, then any one of them may be initiated when the individual goes in to that environment. There is nothing unusual about this. It happens continually. When we go into a church certain habits of behavior are automatically initiated and others are not called out because they have never been practiced in that environment. Churches could save an appreciable amount of money if they would make the pews easily movable so that when they wished to have a church dinner they just push the pews back and use the space for tables. Or, if the young people wished to dance they could clear the floor and proceed. There would be no need, then, for all the other rooms which are usually attached to the church structure. But, likewise, it would be much more difficult for a person to assume a reverent attitude in the chapel of the church. Too many other habits and associations would be aroused. It would be impossible in a book of this kind to cover all the contingencies which arise in the use of suggestion but the few examples which have been given will indicate the fact that great ingenuity and psychological knowledge needs to be mobilized if suggestions are to be used in any but the most mechanical fashion. In many cases the posthypnotic suggestion is phrased in such a way that a signal from the hypnotist initiates the action. For example, it may be necessary to have the patient return to the office a number of times and it is desirable to induce hypnosis quickly on these successive

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visits. During hypnosis on the first occasion a posthypnotic suggestion is given to the effect that when the patient receives a certain signal in the office he will immediately go into the hypnotic state. Many hypnotists make an error in the kind of signal they use. For example, the suggestion is frequently phrased as follows: "The next time you return to the office I will count to five and you will be asleep." Frequently this suggestion will work but suppose that the patient does not respond very well. Now, what is the hypnotist to do? He has counted to five but he does not have the desired results. He is running the chance of setting up a countersuggestion just by virtue of the fact that his suggestion has not operated. The principle to adhere to is this: use a signal which does not have such a definite terminus and which also allows the vocal mechanism of the hypnotist to be free. A signal of this sort would be pressure on the back of the hand by the hypnotist's finger. This signal need not terminate until the desired result is accomplished and at the same time by gradually increasing the pressure, a bit of psychological compulsion is added to the suggestion. At the same time the hypnotist can use his vocal mechanism to give suggestions of eyelid heaviness, etc. Occasionally the posthypnotic suggestion to return to the hypnotic state will suddenly cease to operate. The reason for this can usually be found in one or another of the following conditions: first, the subject has been talking to a friend or acquaintance and has been told

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harrowing tales about the "dangers" of hypnosis. These stories have frightened the patient and induced resistance to hypnosis: secondly, the hypnotist on a previous occasion has made suggestions which were not verified. In dentistry, for example, hypnotic anesthesia has been used and the dentist has made the incorrect suggestion that there will be absolutely no pain when, as a matter of fact, the patient did have some pain. This combination of circumstances destroys the prestige of the dentist and the patient may not act upon the posthypnotic suggestion to go back into the hypnotic state. Hypnotic suggestions should be phrased in a manner to escape circumstances of that sort. If the cause is of the first variety, the only procedure is to try to quiet the fears of the patient.