Persuasion & Re-education Hypnotherapy

Lewis Wolberg’s Approach

Copyright (c) Donald Robertson, 2008-2009.  All rights reserved.

In his Medical Hypnosis(1948), Lewis Wolberg, one of the most influential psychotherapists of his day, discussed three main categories of psychotherapy: symptom removal, re-education, and psychoanalysis.  Wolberg refers to re-education under the broad heading of “psychobiologic” therapy, meaning “mind-body” therapy (or what Braid termed “psycho-physiology”).  Wolberg defines this approach as follows. 

Psychobiologic therapy is the name given to a variety of technics, chief among which are guidance, reassurance, persuasion, desensitisation, re-education and reconditioning. […] Psychobiologic therapy is a far more rational form of treatment than simple symptom removal by prestige [authoritarian] suggestion. (Wolberg, 1948b: 135) 

The re-educational approach attempts to identify the client’s individual character traits, his strengths and weaknesses, and to organise his philosophy of life to take account of them.  Wolberg refers to this as an “education in living” consisting in teaching the client “practical ways of overcoming his personality liabilities and of enhancing his assets.” (Wolberg, 1948b: 138). 

Hypnosis is remarkably effective as a catalyst to the various technics used in psychobiologic therapy.  Guidance, reassurance, persuasion, desensitisation, re-education and reconditioning gain reinforcement with its use. […] An increased faith in the therapist caused the patient to respond more forcefully to persuasive and re-educational influences.  In addition, the hypnotic experience has the unique quality of convincing the patient that something definite and important is being done for him immediately.  (Wolberg, 1948b: 142)

 The components of Wolberg’s psychobiologic therapy therefore consist of the following methods,

1. Guidance consists in giving the client direct advice on how to manage their life.  Wolberg notes that this approach is more relevant to more disturbed clients.  Guidance can take the form of recommending hobbies to the client as a means of encouraging social and extraverted activities.
2. Reassurance consists in removing client’s fears, common examples being the fear of insanity or illness, and sexual fears that may be simply unfounded.  Verbal reassurance therefore often includes the correction of basic misconceptions.
3. Persuasion consists in directly motivating the client to adopt a more healthy and rational philosophy of living.
4. Desensitisation, in Wolberg’s terminology, consists in releasing negative emotions from unconscious conflicts by venting or catharsis.
5. Re-education resembles persuasion but places greater emphasis upon acquiring a rational understanding of one’s own personality dynamics.
6. Reconditioning employs behavioural learning theory to condition new habitual feelings and behaviours, and includes the use of techniques pre-emptive of Wolpe’s behaviour therapy. 

Although Wolberg’s “reconditioning” approach was based on behavioural psychology and pre-empted Wolpe’s systematic desensitisation in many respects, his own use of the term “desensitisation” often referred to venting or abreaction of repressed emotions under hypnosis.  I have discussed Wolberg’s use of behavioural psychology and hypnotic desensitisation in more detail elsewhere.  We will turn instead to a consideration of his “persuasion” and “re-education” methods which prefigure modern cognitive therapy in a number of respects. 

The “Persuasion” Approach in Hypnotherapy

Wolberg describes “persuasion” in hypnotherapy as a general “orientation” of the client to rational living.  

Persuasion is based upon the belief that the patient has within himself the power to modify his pathologic emotional processes by force of sheer will, or by utilisation of common sense.  In persuasive therapy, appeals are made to the patient’s reason and intelligence, in order to convince him to abandon neurotic aims and symptoms, and to help him gain self-respect.  He is enlightened as to the false nature of his own concept regarding his illness, as well as the bad mental habits he has formed, and by presenting him with all the facts in his case, he is shown that there is no reason for him to be ill.  He is urged to ignore his symptoms by adopting a stoical attitude, by cultivating a new philosophy of life aimed at facing his weaknesses, and by adopting an attitude of self tolerance.  An attempt is made to bring the individual into harmony with his environment, and to get him to think of the welfare of others as well as himself.  (Wolberg, 1948b: 172) 

He attributes this approach to Paul Dubois, 

The use of persuasion was first advocated by Paul DuBois of Switzerland who held conversations with his patients and taught them a philosophy of life whereby they substituted in their minds thoughts of health for their customary preoccupations with disease and suffering.  Much of the success that DuBois achieved by his persuasive methods was due to his own vigorous personality which exuded confidence and cheer.  (Wolberg, 1948b: 173) 

Wolberg emphasises the importance of a good rapport between client and therapist, therefore.  

DuBois recommended prolonged discussions during which it was necessary to convince the patient of his errors in reasoning.  He had to be shown that his symptoms were the product of emotional stress.  Though annoying, they were not serious in themselves.  The less one concentrated on symptoms, the less disturbing these would become.  If the heart palpitated, let it pound; if the intestines were active, let them grumble.  If one had insomnia, he had best say: “If I sleep, all the better; if I don’t sleep, no matter.”  Undue attention aggravated the difficulty. The best way to overcome symptoms was to stop thinking about them.  Fatigue, tension and fear were all exaggerated by attention.  (Wolberg, 1948b : 174) 

Clients are encouraged in this approach to stop dwelling on their symptoms and focus instead on the idea of improvement, to seek out evidence of their progress and monitor it closely.  

One of the most important elements in therapy was to question the patient about his conceptions of life and his philosophy.  False views were to be criticised, and those viewpoints that were logical and helpful were to be encouraged.  The physician had to make an effort also to discover in the patient qualities of superiority that would elevate him in his opinion [i.e., positive qualities and strengths that would raise his self-esteem].  It might even be necessary to teach him to make an optimistic inventory of his good qualities.  (Wolberg, 1948b: 175) 

Wolberg claims that in the late 1940s “persuasive” psychotherapy methods in general still drew heavily on the earlier work of DuBois and his successor Dejerine.  All these approaches motivate clients to adopt a consistently more healthy and rational philosophy of life, and to face up to their practical problems, or learn to accept those (such as certain illnesses) that they cannot physically change (1948b: 176).  As Wolberg notes, of course, the therapist cannot force the client to adopt a philosophy of life which clashes too much with their existing traits, so care must be taken to tailor persuasion to the client’s personality type.           

Wolberg further sub-divides persuasion psychotherapy methods into the following categories which include re-appraisal of one’s goals in life, psycho-education about the stress response, problem-solving training, thought-substitution, relaxation training, and training in acceptance of one’s situation, similar to the Serenity Prayer. 

1.  Redirection of goals.

The client is encouraged to consider his goals in life and whether he is pursuing materialistic goals (wealth), egotistic goals (fame), or a more philosophical ideal of personal happiness and well-being.  Many people benefit from a re-evaluation of their fundamental goals in life and improvement often consists in sacrificing some more superficial goals for the sake of investing more time and energy in the pursuit of genuine serenity or happiness.  

One can attain happiness and health by learning to live life as it should be lived, by taking the good with the bad, the moments of joy with the episodes of pain.  One must expect hard knocks from life and learn to steel himself against them.  It is always best to avoid foreboding and anticipations of what might happen in the future.  Rather one should aim for a freer, more spontaneous life in the present.  He should take advantage of the experiences of the moment, and live for every bit of joy he can get out of each day.  The place to enjoy life is here; the time is now.  By being happy oneself, one can also make others happy.  (Wolberg, 1948b: 178) 

It is particularly important to challenge feelings of hopelessness which prevent constructive action from being taken to pursue legitimate goals in life.

            Wolberg doesn’t mention this, but it makes sense in this regard to ask clients to calculate how much time they actually dedicate toward their highest priorities in life each week, and how much is spent on more trivial activities or diversions.  An action plan can be drawn up for the pursuit of primary goals and steps taken to ensure that the client makes progress in this area.  The therapist may also wish to help the client evaluate their goals by thinking through the consequences of adopting different priorities in life. 

2.     Overcoming physical suffering and disease.

The client should be educated to understand the powerful effect that the mind has over the body and physical health. 

The patient, if he is suffering from ailments of a physical nature, may be told that physical symptoms are very frequently caused by emotional distress.  Studies have shown that painful thoughts can affect the entire body through the autonomic nervous system.  For instance, if we observe an individual’s intestines by means of a fluoroscope, we can see that when the person thinks of fearful or painful thoughts, the stomach and intestines contract, interfering with digestion.  On the other hand, peaceful happy thoughts produce a relaxation of the intestines and a restoration of peristaltic movements, thus facilitating digestion.  The same holds true for other organs.  Understanding the powerful effect that mind has over body is important, for it lends scientific proof to the fact that physical suffering can be mastered by a change in attitudes.  (Wolberg, 1948b: 179) 

Many illnesses are caused by bad habits of thinking and negative emotions.  The true cause of physical illness must be identified and addressed.  Where the client suffers from a genuine organic illness, they must learn to accept the limitations of their situation as peacefully as possible, without adding additional worry or distress.  Where the illness is due to worry or tension, this should be emphasised and corrected.  The patient is persuaded not to dwell morbidly on their bodily problems, but to engage in positive activities and hobbies which divert their attention from themselves in a healthy manner. 

3.     Overcoming the “worry habit.” (Problem-solving)

Clients are taught to see worry as a futile expense of energy, the opposite of constructive planning behaviour. 

Patients who are obsessed with worrying about themselves may be urged to remember that worry is a state of tension in which energy is spent ruminating about one’s problems and fears, instead of doing something positive about their solution.  Worry tends to magnify the importance of petty difficulties, and usually paralyses initiative.  The worrier’s thoughts are constantly preoccupied with ideas of fear, dread and morbid unpleasantness.  These thought shave a disastrous effect on the motor system, the glands and the organs.  (Wolberg, 198b: 181) 

Instead, Wolberg asked clients to clearly formulate their chief problem, setting aside morbid feelings while evaluating it from a more rational perspective.  The client is persuaded to think things through carefully, logically and objectively.  In a manner very reminiscent of problem-solvingapproaches in CBT, Wolberg instructs clients first to adopt this calm, rational orientation to the problem, before taking the following steps. 

It is necessary to review all possible solutions for the problem at hand.  Next, the best solution is chosen even though this may seem inadequate in coping with all aspects of the problem.  A plan of action must then be decided on.  It is then necessary to proceed with this plan of action immediately, and to abandon all worry until the plan is carried out as completely as possible.  Above all the person must stick to his plan of action, even if he finds it distasteful.

                If the person himself cannot formulate a plan, the physician may help him to do so.  The patient should be told that it is better to concern himself with a constructive plan than to get tangled up in the hopelessness of an apparently insoluble problem.  Until he can work out something better, it is best to adjust himself to the present situation, striving always to externalise his energy in a constructive way.  (Wolberg, 1948b: 182) 

While working on his plan, the client should make a deliberate effort to exclude worrying thoughts and to avoid unnecessary discussion of distressing subjects with others, i.e., to minimise “moaning”, “complaining”, “whinging”, and other morbid patterns of speech and behaviour.  He is motivated to focus all of his energy away from worry and on to the solution he is testing out in practice. 

4.     “Thought control” and “emotion control.”

Through dedicated practice, clients can learn to reduce worrying thoughts and replace them with thoughts of health and confidence. 

Emancipation from tension and fear can come by training one’s mind to think joyous and peaceful thoughts.  But new thought habits do not come immediately.  One must show persistence and be steadfast in his application.  One must never permit himself to be discouraged.  He must practice, more and more.  Only through persistent practice can perfection be obtained, so that the mind shuts out painful thoughts automatically.  (Wolberg, 1948b: 184) 

However, as Wolberg emphasises, mere “willpower” is not the answer, as negative thoughts must be counter-acted by habitually cultivating contrary positive thoughts and images.  Wolberg, like Assen Alladin, recommends frequently thinking of happy memories in order to make these more habitual, and thereby counter-act negative thoughts. 

It is not necessary to force oneself to stop worrying or to force oneself to stop feeling pain, or anxiety, or tension.  Will power used this way will not crowd out the painful emotions.  One must substitute different thoughts or appropriate actions.  If he starts feeling unhappy or depressed, he should immediately raise his head and determine to rise above this emotion.  He should talk cheerfully to others, try to do someone a good turn or he may lie down for a short while, relax his body and then practice thinking about something peaceful and pleasant.  As soon as this occurs, unhappy thought swill be crowded out, and the entire body will respond.  A good practice is to think of a period in one’s life when one was happiest.  This may be in the immediate past or during childhood.  One may think of people he knew, the pleasant times he had with them.  This substation of pleasant for unpleasant thoughts may take several weeks before a new thinking habit results.  (Wolberg, 1948b: 184-185) 

This process seems to perhaps be influenced by James Alexander’s earlier method of “thought control” although Wolberg does not reference any particular source. 

5.     Correcting tension and fear.

Wolberg emphasises that clients should come to see tension and anxiety as originating from their own disposition rather than from external events.  Adopting a more detached attitude or learning to laugh at one’s fears can be a powerful remedy.  However, Wolberg also recommends specific relaxation skills training methods. 

Practising relaxation may be very helpful.  Each day a person may lie on his back, on the floor, or on a hard surface for twenty minutes, consciously loosening up every muscle from his forehead to his feet, even his fingers and toes.  He may then start breathing deeply, with slow, deep exhalations through pursed lips.  At the same time he may think of a peaceful scene at the mountains or seashore.  Mental and muscular relaxation are of tremendous aid in overcoming states of tension.  In spite of his fears, he should continue his work and not yield to his irrational emotions.  (Wolberg, 1948b: 186) 

6.     Facing adversity.

Wolberg means by this that clients should be counselled in adopting an accepting attitude, an attitude of resignation, toward unavoidable problems.  Clients should be discouraged from exaggerating their difficulties by comparing their situation in life rationally, with others who cope well despite more hardship.  Again, Wolberg’s advice here very much resembles Stoic philosophy, “The sign of character is to change those conditions that can be remedied and to accept those that cannot be changed.” (Wolberg, 1948b: 188).  

There are always, of course, situations one must accept.  Facts must be faced.  If one cannot change things as they are, he can change his own attitude so that he will not overreact to his difficulties.  As soon as a person has decided to make the best of things, his condition will improve immediately.  Progress will be made in changing oneself.  One must accept some difficulties that life imposes on him without struggling or rebelling.  (Wolberg, 1948b: 188) 

Wolberg recommends the use of a list drawn up between sessions, again a strategy resembling cognitive therapy, 

Keeping two lists, on one side the things that have troubled him, on the other side the things that have gone in his favour, will often convince the person, after a while, that the balance is on the positive side.  (Wolberg, 1948b: 188-189) 

Wolberg, it has to be said, felt that persuasive psychotherapy was very limited unless supplemented by psychodynamic techniques which identify and resolve unconscious emotional conflicts.  However, the place of these methods might be taken by more experiential methods used in modern CBT and hypnotherapy.  He does, however, claim that he has found rational persuasion more effective than other methods in the treatment of obsessive compulsive personalities.  Persuasion methods were also supplemented, however, by “desensitisation” and “re-education” in psychobiologic hypnotherapy.

The “Re-education” Approach in Hypnotherapy

Re-education is a more rational extension of persuasive psychotherapy, according to Wolberg, insofar as it recognises the client’s personality traits and their role in his problems.  In a manner resembling the schema psychology of modern cognitive therapy, Wolberg attempts to identify these traits and teach the client how to deal with them better. 

Reaction patterns are always elaborated to preserve the integrity of the individual, to insure his security and self-esteem.  As a result of disturbing early experiences and conditionings, the person may become excessively dependent, perfectionistic, or power-driven, or he may develop the notion that he cannot depend upon anyone except himself.  He may harbour bloated ambitions, and expectations of himself may become inordinate and out of proportion to his intelligence, capacities, or available opportunities.  He may belief that others must fulfil his demands and consequently show little spontaneity and initiative.  He may detach himself from people and attempt to function without ties to others.  He may be resentful and fail to establish any form of satisfying relationship with another person.  Countless other attitudes and impulses may develop on the bedrock of unfortunate early experiences, and these are incorporated in the adult character structure.  (Wolberg, 1948b: 199-200) 

As Wolberg observes, merely gaining insight into the existence of these character drives within oneself seldom changes them.  People often know they are being overly-perfectionistic, but continue to find themselves habitually acting in the same way.  However, fully recognising the nature of one’s character drives is an important first step in treatment.  

The process of changing character responses is difficult and prolonged.  It consists of bringing to the conscious attention of the person his maladaptive attitudes, demonstrating to him what difficulties are consequent to their exploitation.  The person is shown the reasons for their development in his past life and for their persistence in the present.  Finally, he is helped to adjust with new, healthful, adaptive patterns.  (Wolberg, 1948b: 201) 

However, in the psychobiologic approach, the emphasis is not on uncovering the childhood roots of a problem but on the retraining new patterns of thinking and behaviour.  In particular, Wolberg refers to the re-educational system of Dr. Austen Fox Riggs in his books Just Nerves (1922) and Intelligent Living (1929). 

            Wolberg observed that although re-education should ideally be tailored to the client’s personality, that some clients could be helped by prescribing reading about general personality problems, such as Riggs’ books provide.  When the therapist has an opportunity to do so, he may interpret the client’s problems in terms of personality traits which can be addressed.  Wolberg recommends having clients draw up lists of their personal strengths and weaknesses, another method that is found in modern cognitive therapy.  Martin Seligman’s positive psychology approach, in Authentic Happiness (2002), also helps individuals to identify their personal strengths and focus attention upon making better use of them.  

The physician teaches the patient to regard his symptoms as the product of emotions and distorted goals in life.  He outlines for the patient the disturbed attitudes and strivings which get him into difficulties with people.  Next he helps the patient apply the knowledge about himself to immediate life situations.  An evaluation is made of the patient’s assets and these are compared with his liabilities.  From this the patient often learns that he has concentrated upon his liabilities more than on his assets.  He may come to the realisation that he has been so provoked by his failures that he has minimised any good qualities that he possesses.  Indeed when his assets are brought to his attention, he may be surprised that he has accepted them without realising their proper value.  He may gradually become cognisant of how exclusively he has focused his attention on his bad features, blotting from his mind his good points.  Redirecting his attention on the latter gives him new goals toward which to strive.  This may break up a vicious chain of frustration and despair.  An investigation of the patient’s objectives may disclose ambitions that he is unqualified to fulfil which have contributed to his sense of defeat.  An attempt is made to modify these ambitions within the range of the patient’s capacities, energies and environmental opportunities.  (Wolberg, 1948b: 203) 

This approach may resemble the giving of guidance mentioned above, but is more “non-directive” insofar as the client is encouraged to assess his own strengths and weaknesses and set new goals for himself in the light of these traits. 

Re-education may take the form of teaching the patient to think unemotionally, to face facts bravely, to adjust to painful memories and impulses without panic, to meet stresses of life with courage, and to forsake fantasy in thinking.   Each trait that the patient exhibits may be taken up in detail, discussing its origin, purpose, value to the individual, and the ways it interferes with his happiness and adjustment.  More adaptive substitute patterns may then be instituted.  (Wolberg, 1948b: 204) 

Focusing on specific strengths and weaknesses allows the client to be clearer about his goals, and to explore what specific changes he will need to make in his daily routine, or in concrete situations, in order to gradually shift closer toward a more adaptive philosophy of life.

Psychobiologic Hypnotherapy Suggestions

Wolberg gives the following transcript of re-educational suggestions given in group hypnosis sessions, probably based on Riggs’ group re-education approach, which combine some of the elements described above. 

You have acquired faulty emotional habits that need correction.  Such habits are the result of the wrong kind of thinking.  You can be happy, free from worry and tension, by establishing the right habits of thinking and acting.  You must tell yourself, “I will correct those difficulties that can be remedied.  I will face those that cannot be remedied.  I may be unable to change the world, but I can change myself so that I will not get emotional about things.  I will abolish worrying and thinking too much about myself.  If anything comes up that needs solution, I will immediately review all possible courses of action and choose the one that seems to be best.  Once I have made up my mind, I shall follow the plan I have evolved.  I shall stop thinking and talking too much about my troubles.  I shall be pleasant in my relationships with people, and shall not permit myself to be upset.  I shall direct my thoughts to pleasant things, and keep in mind the kind of person I would like to be.  I must think I am well, and then I will get better.  If worrisome ideas keep coming up in my mind, I shall control my thoughts by picturing in my mind a time in my life when I was really happy.”  (Wolberg, 1948a: 183-184) 

This is an early example of direct suggestion being used to reinforce prior cognitive re-education.  Although crude, it clearly pre-empts subsequent cognitive-behavioural approaches to hypnotherapy in many respects.