Thursday, May 28, 2009

The Dark Side of Milton Erickson

Milton Erickson has become a highly revered figure among certain anti-cult activists.

I wonder if such activists are aware of the following method, recommended by Erickson in a journal article in 1962:

Erickson, M. H. (1962). The identification of a secure reality. Family Process, 1(2), 294-303.

Erickson’s methods had no research in the form of well designed controlled studies, to support them. His typical style of presentation was telling detailed clinical anecdotes, and being the great story teller he was makes this one all the more horrifying. In this article, he presents a case of an 8 year old boy who was combative, defiant and having serious behavior problems in spite of his mother’s repeated attempts to discipline. Finally, the exasperated mother took the boy to see Erickson and followed his advice. The following weekend, the boy was engaging in his usual oppositional behavior, demanding breakfast from his mother. The mother carried out the following, as instructed by Erickson [later in the article he makes it crystal clear that these were his instructions she was following – he emphasized how she needed to put her full weight on the boy]:

Erickson, 1962, p. 296-297 [Please note that I am properly citing and quoting this because some true AT believers have tried to have things removed from other websites with bogus charges of copyright violations. This is fair use.]:

His mother merely smiled at him, seized him, and threw him quickly to the floor on his stomach and sat her full weight upon him. When he yelled at her to get off, she replied mildly that she had already eaten breakfast and she had nothing to do except try to think about ways to change his behavior. However, she pointed out that she was certain she did not know any way, therefore it would all be up to him.

The boy struggled furiously against the odds of his mother’s weight, strength, and watchful dexterity. He yelled, screamed, shouted profanity and obscenities, sobbed and finally promised piteously always to be a good boy. His mother answered that the promise did not mean anything because she had not yet figured out how to change his behavior. This evoked yet another fit of rage from him which finally ceased and was followed by his urgent plea to go to the bathroom. His mother explained gently that she had not finished her thinking; she offered him a towel to mop up so he would not get too wet. This elicited another wild bit of struggling which soon exhausted him.

He goes on to describe how the mom, while sitting on the boy, chatted on the phone, ate fruit and drank coffee. She allowed the boy to get up and go to the bathroom once during the torture (p. 297):

Shortly before noon the boy politely told her he really did need to go to the bathroom. She confessed a similar need. She explained that it would be possible if he would agree to return, resume his position on the floor, and let her sit down comfortably upon him. After some tears, he consented. . . .After over five hours, Joe surrendered by stating simply and abjectly that he would do anything and everything she told him to do. Her mother replied just as simply and earnestly that her thinking had been in vain; she just did not know what to tell him to do. He burst into tears at this but shortly, sobbing, he told her he knew what to do. She replied mildly that she was very glad of this but she did not think he had had enough time to think long enough about it. Perhaps another hour or so of thinking about it might help.

After another hour, the mom finally let him go, after she finished reading her book chapter, but the sadistic behavior of the mom, as advised by Erickson, continued and she deprived him of all his meals for an entire day (p. 297).

With the chapter finally finished, the mother got up and so did Joe. He timidly asked for something to eat. His mother explained in laborious detail that it was too late for lunch, that breakfast was always eaten before lunch, and that it was too late to serve breakfast. She suggested instead that he have a drink of ice water and a comfortable rest in bed for the remainder of the afternoon.

Erickson then goes on to describe how Joe awakened to odors of dinner being served, but his mother would not allow him to have dinner because “it was customary first to eat breakfast and then lunch and then dinner.” He had missed breakfast and lunch, so now he would have to miss dinner. He was not allowed to eat until the next day. The next morning. The whole family had pancakes and sausages the next morning except for Joe, who was made to eat only oatmeal. Later for lunch, he was only given “cold, thick sliced oatmeal” and for the evening meal was only allowed leftovers.

Erickson described how he “educated” the mother: p. 298-299:

The education of Joe’s mother to enable her to deal with her son’s problem by following out the instructions was a rather difficult task. She was a college graduate, a highly intelligent woman with a background of social and community interests and responsibilities. . . The mother’s apparently justified statement that her weight of one hundred and fifty pounds was much to great to permit putting it fully on the body of an eight your old child was a major factor in winning the mother’s full cooperation. At first this argument was carefully evaded [I assume he means that he, Erickson evaded it].”

He finally managed to manipulate the mom into agreeing to carry out his instructions, against her common sense objection about her weight on the boy. At the end of the article, Erickson brags about how Joe became unquestioning about whatever he wanted.

He also noted: p. 303:

Joe is not the only patient on whom this type of therapy has been employed. Over the years, there have been a number of comparable instances, some almost identical.

Erickson’s work had no controlled studies to support it and this rather chilling anecdote makes me wonder just what his goal was. It looks to me like it was to have been a boy who would be unquestioningly obedient. This “cure” may have been worse than the problem itself if it produced a mindlessly obedient child. What sort of message does this send? Is this what people fighting cults want to endorse? How ironic.

The article is eerily reminiscent of the writings of many AT proponents who had very similar advice about parenting children with behavior problems and alleged “attachment disorders”.
For instance, there is this quote from AT parenting "coach" Nancy Thomas quoted on a website exposing AT abuse:

I have had instances where a kid is so out of control that they refuse to stay. When that happens, I will sit on the child. I have had to do this with dogs as well, and they are generally more dangerous with their teeth and claws than children. … I pick a good book and read while I sit on a child and that really seems to upset them because they feel that I should be miserable like they are. ---Bonding & Attachment Workshop (Chatsworth, CA: Foster Care & Adoptive Community,Online Training Program, nd, 2 parts) [material currently available for CEUs]

I wonder if Nancy got this idea from Milton.

I found out about this 1962 article through Jean Mercer who had mentioned Erickson on her blog. I asked her for the reference, she gave it to me and I was able to obtain a hard copy of the article, which I reference above. Although I have read worse in commercially published books on AT, this is by far the most horrendous article in a professional journal I have ever read. Google Milton Erickson and you’ll find pretty much all positive accounts. I have to wonder how many people actually read his writings and were aware of what he actually did. This shows how far abuse of children in the name of mental health practices dates back. I regret that abuse and torture are about the only words I can think of to describe this published work. Knowing now what happened to Candace Newmaker in 2000, who was smothered to death when several adults put their full weight on her while she was wrapped a blanket, I have to wonder if Erickson's influence may have played a role although of course they took this procedure to much more of an extreme. Some mental health professionals today would like to turn a blind eye to all of this and say it is in the past, and to mention it is mere "sensationalism" but is it realistic to believe that all this would just suddenly go away? While hopefully there is now more awareness about such abusive practices, I hardly think that is a realistic point of view to think that and to slam anyone who tries to mention it as being "sensationalistic". No, some of us are not so willing to sweep all this under the rug.


  1. NLP doesn't have much to recommend either.

    What do the anti-cult people see in Erickson?

  2. That's a good question, Linda. It would certainly make sense that people who are against cults would want to avoid this kind of thing like the plague, but that's not the case. The rationale behind studying NLP Hassan gave is that he wanted to learn more about how "mind control" works, to understand it better. However, he took it further than that and after studying the work of people such as Erickson on which NLP is based, used what he learned to, he feels, be more effective at communicating with people, including instructing family members on how they might influence their cult involved loved one to change and realize that they're in a trap. Some of this, particularly when it takes the form of a covert intervention, has generated considerable controversy because we now have to ask whether this is not the same thing that cults are doing in terms of influencing a person without his or her knowledge or permission. Proponents of this covert method justify it by saying that the person would not respond to a more up front approach. In other word, the end justifies the means, not all that different from the kind of rationale cults use to influence without permission.

  3. Hassan move to California to begin an apprenticeship with John Grinder PhD to become an NLP trainer in the 1980s. I believe Grinder encouraged Steven to learn from Virginia Satir, Milton Erickson and Fritz Perls, the reknown therapists upon which NLP was based. Using what he learned from NLP and from those therapists Hassan learned from Satir, Perls and Erickson, he created an explicit model of how people enter cults and how they successfully exit cults. Hassan has helped many people find the personal resources they need to cut the ties and leave dangerous cults on their own terms.

  4. Being very familiar with Steve Hassan's work (having worked on numerous cases with him) I think proponents of NLP give NLP and related people far too much credit for his work. He studied this for a few years and while these people did have some influence, what tends to get lost is that after that he studied some of the major Cognitive-Behavioral people who had a strong influence on his work (for example, phobias). His phobia intervention is far more like CBT than it is like NLP.

    Also neglected by NLP proponents is Hassan's study of hypnosis of people such as Barber (presented in his most recent talk) who as far as I know were not NLP people. Hassan has drawn on many different sources and while NLP was one very early influence on him, I would not say that his model is based on NLP (I doubt he would either) -- that's giving NLP far too much credit.

    Of course, there are many elements of NLP that are really not much different from CBT approaches and since CBT is well empirically tested, CBT principles could well be what is workable about NLP, rather than anything unique about NLP. And NLP most certainly does not have a monopoly on the idea of finding "personal resources". That idea has been around for a long time and while NLPers like to repeat that phrase, it is hardly original or unique to NLP.

  5. I don't know enough about Hassan's specific techniques for treating phobias to compare it with standards treatments in CBT. From what I have learned about CBT at university, a typical CBT intervention might involve (1) structured interview to identify problems, make diagnosis using DSM and plan treatment. The typical treatment might involve (2) imaginal exposure to alleviate fear and (3) reconnect memory with other autobiography memories, (4) perspective taking to get some psychological distance, combined with (5) cognitive restructuring to challenge distorted thinking patterns.

    I can see parrallels with a typical approached used by some NLP practitioners: (1) well-formed outcome process to establish present and desired state, (2) rewind technique or VK/D to reduce unwanted negative feelings attached to memory, Dilt's reimprinting to (3) relive experience with adult resources from (4) multiple perceptual positions, combined with (5) meta model to challenge distorted beliefs and faulty thinking.

    I think there has been a great deal of cross fertizilation between these approaches. Yet there are some fundamental differences. CBT has an active technique-driven approach whereas NLP is more inclusive and relational. The CBT therapist seems to frame themselves as the authority whereas in NLP practitioner is more permissive in the style of Erickson. Some of the cognitive restructuring can quite contronting. NLP practitioners would consider exposure therapy to be ethical questionable. This should definitely be avoid with sexual abuse victims. In my opinion the NLP alternative to exposure (VK/D and reimprinting) is far more elegant and nicer to the participant. The "exposure" only occurs after the person is fully resourced and it is driven by feedback. The meta model and reframing techniques from NLP are often softer when skillfully combined with timing, metaphor and Milton model.

    I think NLP could benefit from some rigorous empirical testing. There has been little (if any) well-controlled comparison studies of CBT v. NLP. Many trainers/authors of NLP argue that NLP is not an approach to psychotherapy at all. CBT could be improve if it tested and adopted some of NLP's processes (and referenced!) such as use of metaphor and content free work for dealing with issues that the patient does not want to discuss openly. One of the failings of CBT is that it does not work as well with men. Most men are just not interested in imaginal exposure because they don't want to expose their personal information. They would just not come back. Many men are just suffering from fear related condition and PTSD in silence. In this respect NLP has an advantage because NLP practitioners can work content free, the patient does not have to devulge anything about their trauma or personal history. Unfortunately, working content free takes many years of training to master and does not fit with the goal of many short CBT and NLP training programs.

    Only recently have there been comparision studies comparing CBT v. IPT. In the short term IPT was not as effective than CBT but after 12 months IPT was found to more effective than CBT for treatment of PTSD. The longer term benefit of IPT was attributed to its emphasis on developing relationships and interpersonal skills. I think the NLP approach is closer to IPT than CBT in this respect. It would be interesting to see some rigorous studies include NLP practitioner with proper training in future comparisons to see what the longer term benefits are (if any) of NLP. I am studying CBT at the moment as part of a psychology degree and I am impressed with many aspects especially the integration of evidence from neurobiology into CBT theory and practise. I'd like to see NLP proponents follow suit: document and submit your models for empirical scrutiny so they can be incorporated into the evidence-based practise.

  6. I am stunned that you would portray Erickson as permissive and not authoritarian. Have you ever actually read Erickson? I have to wonder, since he put himself up as the ultimate authority, while doing covert hypnosis on people and leading them with language patterns, which made him appear permissive when he was really controlling the person. I suggest you sit down and read the case I referred to with the mom who sat on her child. I doubt that most NLPers who have this "permissive" image of Erickson have actually even read him. In this particular example, he boasted of how unquestioningly obedient the child had been, who in the end, was completely deferring to Erickson as the authority figure.

    As for CBT and NLP, of course there are differences between NLP and CBT, although CBT is a theory, not just the kind of technique driven procedure you describe -- there are many techniques based on CBT, as there are with NLP. What you described is more of a protocol, certainly not any one set procedure.

    But the real question here is whether those differences between NLP and CBT, make any difference in outcome or if the only reason NLP works, NLP's real mechanism of action, is the elements of CBT. Since dismantling studies on NLP have not been done comparing it to CBT, there is no evidence that there is anything specific to NLP that makes a difference in outcome.

    Perhaps a different example that has been researched would make this clearer. EMDR has been compared to exposure therapy in dismantling studies, with and without the eye movements and the studies showed that the eye movements made no difference. In other words, the procedure was effective, regardless of whether the person moved eyes from side to side. The active ingredient is exposure to the trauma, which lead Richard J. McNally to correctly point out that "what is new in EMDR [the eye movements] does not appear to be helpful and what is helpful [exposure] is not new".

    The same could very well be the case with NLP, but unlike EMDR, NLP has not been extensively researched with randomized controlled studies that tested different elements.

  7. Part 2 of my response:
    As for your statement that exposure therapy is unethical, especially with sexual abuse victims, it seems to me that you don't seem to understand it. First of all, exposure therapy has been shown to be safe and effective for sexual abuse in RCTs. Second, the protocol is not as you attempt to portray it here. People are not just pushed into traumas, nor are they confronted with things. The protocols are driven by client feedback and graded heirarchies established by the client are used. Again, you knowledge of CBT-based procedures appears to be very limited, perhaps based on some old, outdated protocols or the way it is used by therapists who are not knowledgeable, rather than the way it is currently used by knowledgeable, well trained people. In CBT we can speak meaningfully about treatment fidelity because it has been critically tested to make a difference. The same cannot be said for NLP, where the concept of treatment fidelity is meaningless because it has not been demonstrated that any of it is effective, done correctly or not.

    And where do you get that NLP takes many years of training to "master"? The master practitioner course can be done in a matter of months, or even days, depending on how the trainer has it scheduled.

    In any case, there is no basis for making claims regarding NLP because it has not been critically tested and the burden of proof is on proponents to do so. However, I do suggest you actually read the Erickson case I referred to above and broaden your horizons about CBT-based approaches which do not fit the stereotypes you attempt to impose on them.

  8. And just to add one more thing about the portrayal of NLP practitioners as so permissive and non-authoritarian, that depends on the practitioner's personality. In my experience, some of the most authoritarian people with the biggest egos I have ever seen are NLP people. They may know how to cloak it in NLP and appear permissive to the naive observer, but to someone such as myself who is experienced at spotting authoritarianism and knows the patterns that hide it, it is all too obvious. With covert NLP, there is a lack of respect, in my opinion, for the client who is being lead and manipulated sans informed consent. I realize not all NLP is done that way, but there are plenty of "masters" who do operate in that manner, as a challenge to your generalization.

  9. i suffer from post traumatic stress disorder and OCD. after CBT and EMDR i found neither of these worked (for me). I then decided to learn more about PTSD and OCD. And helped myself by simple techniques such as relaxation, understanding and open mindedness. is wasn't easy bt i feel great now and after 2 years off work i am going back next month. What i am saying is before you can beat something you must understand it