Hypnotic Ego-Strengthening Procedure

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

Hartland later discovered that his "ego-strengthening procedure" could successfully address a wide range of clinical circumstances, on its own, as the sole form of therapy.

The insights, observations, technical developments, and procedural innovations of Émile Coué, the French scientist,[12] apothecary (i.e., a first-contact prescribing pharmacist, a compounding and dispensing chemist, and a pharmacopolist that sold proprietary medicines), hypnotist, and psychotherapist in relation to his understanding, conceptualization, realization, and application of hypnotherapeutic suggestion have greatly influenced the theories and practices of hypnotism throughout the English-speaking world.

[13][14][15] Initially apprenticed to a small Apothecary in Troyes in 1876, where "he learned to examine and diagnose; prescribe and compound medicines; regulate, control, and operate a chemical laboratory; and promote, market, and sell proprietary medicines and his employer's concoctions","[19] Coué won a government scholarship in 1879 to the prestigious Collège Sainte-Barbe, graduating with First Class Honours in Pharmacology, at the top of his class in July 1882.

"[20] In 1885, Coué's father-in law, the eminent French horticulturist Victor Lemoine, introduced him to Ambroise-Auguste Liébeault,[22] a medical practitioner in nearby Nancy, France.

His dormant interest in hypnotism reawakened, he purchased the associated correspondence course material produced by "Professor Xenophon LaMotte Sage, A.M., Ph.D., LL.D.

[45] Having immediately recognised that Sage's Braid-style approach was ideal for mental therapeutics, Coué began an intense study of the course material, and was soon skilled enough to offer hypnotism (free of charge) alongside his pharmaceutical enterprise.

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

[52][53] Hartland was convinced that hypnotherapy could be usefully applied, by G.P.s, to a wide range of clinical conditions, regardless of their familiarity with hypnotic theories and practices,[54] At a time that "for many, hypnotism was far from respectable, regardless of whether delivered by a medical practitioner, or not" (Yeates, 2014a, p. 5),[55][56] Hartland's "ideas and practices were disseminated worldwide",[57] through the lectures, demonstrations, and seminars he delivered towards the end of his career throughout the U.K., France, Sweden, Australia, USA, and Singapore.

[63] From this, Wolberg observed, the appropriateness of the operator's chosen "therapeutic program" was contingent upon three dimensions: Given the importance that he attributed to the dimension of "ego strength" as a significant predictor of therapeutic success,[66] Wolberg was also well aware that, In 1985, the British psychiatrist Brian Lake (1922-2008)[67] observed that "the concept of ego strength is recognised by most psychiatrists, used by some, and defined by few ... [and,] as with the notion of "mental health", many clinicians have an image of ego-strength, but no-one seems fully satisfied with any one else's definition"; "nevertheless, [he continued,] ample evidence exists in textbooks and research articles that the dimension of ego strength and weakness is used as a significant predictor of outcome for psychotherapy, despite its components often being dissimilarly identified, described, and measured".

[70] Given the common-sense understanding of the extent to which "psychological and behavioral factors may adversely affect the course of medical conditions in almost every major disease category",[71] Hartland's interventions addressed two inter-connected psychological issues: Because the time pressures of his busy general practice clearly "excluded any serious attempt to employ hypno-analytical techniques" — and, having discovered that "direct symptom removal [was] both difficult and unsatisfactory in many cases" — Hartland set about "[trying] to evolve a series of standard psychotherapeutic suggestions which [he] could employ at every session before trying to tackle the main symptoms".

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

5-35), with an abridged, rapidly-delivered versions of his presentation available as gramophone recordings (1923a); and a further, detailed explanation/elaboration of the rationale behind his "ego-strengthening" suggestions had been provided at Coué & Orton, 1924, pp. 80-88.

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

Hartland was emphatic that the published, "full and unabbreviated version" of his "ego-strengthening" monologue (which was a direct transcription of one of his interventions)[97] was provided to deliver an understanding of the incremental suggestive sequence (its critical feature),[98] and that alone — a guide to the "principles underlying the construction and usage of this type of technique" (viz., the "important factors" worth "attention").

[100][101] A number of "improved" versions of Hartland's "ego-strengthening" monologue have been published — with, perhaps, the most extraordinary being the "Poetic Hypnogram" of Samuel Silber, M.D.

[106] Assuming that whatever "measurement" (presence, absence, degree of change) made of an object/attribute has been made with a reliable, accurate device, and that the measuring device has delivered a precise value of so-and-so, two important conceptual issues arise in relation to abstractions such as "ego-strengthening":[107] Given the wide range of substantially different meanings, conceptualisations, and applications to which the expression "ego-strengthening" has been applied by its many different users (each operating from a different theoretical orientation),[110][111] any appraisal of the efficacy of "ego-strengthening" involves two embedded questions: Setting aside the complex issues of determining precisely how a "genuinely productive experiment" might (or might not) possibly be constructed to measure its efficacy — or how, where, and upon whom a relevant, informative, and useful study might (or might not) be designed and performed — and, further, if were to be conducted, how its results might be measured and appraised, there is the even-more-significant question of the extent to which any such findings could have any practical application at all,[118] due to the differences in contexts identified by Gorman (1974): In 1977, in perhaps the only investigation that ever attempted to measure the efficacy of Hartland's monologue within a clinical setting,[122] Calnan's study reported that the ten psychiatric patients (test population: 40) who had received Hartland's monologue, under hypnosis, 12 times in 6 weeks, demonstrated (per medium of "psychological tests") considerable progress (i.e., compared to the other 30);[123] the most interesting/relevant outcome of his interventions was that: Hartland's overall "ego-strengthening" approach, clinical strategies, explanations, and his descriptions of the suggestive sequences (for within-hypnotic influence and post-hypnotic influence) he delivered in practice, have made a considerable contribution to modern hypnotherapeutic practice.

Despite the obvious difficulties in determining its clinical efficacy, Hartland's approach clearly satisfies the APA's tripartite criteria for clinical utility:[124] There are many reports of hypnotherapeutic interventions, directed at a wide range of conditions,[127] that describe the valuable contribution that the adoption of an overall ego-strengthening approach has made to their treatment outcomes, in relation to building confidence, enhancing self-esteem, facilitating behavioural change, arousing dormant resources, promoting overall well-being, increasing a sense of self-efficacy and self-empowerment, and strengthening the sense of an internal locus of control:[128] including, for instance, Melzack & Perry (1975); Deabler (1976); Gardner (1976); Stanton (1977); Stanton (1979); Newey (1986); Palan & Chandwani (1989); Stanton (1989); Barber (1990a); Barber (1990b); Hammond (1990b); Hammond (1990c); Watkins (1990); Darken (1992); Stanton (1993); Bennett (1994); Vanderlinden & Vandereycken (1994); Moss & Oakley (1997); Daniel (1999); Frederick & McNeal (1999); Hornyak (1999); Linden (1999); Lynch (1999); Mutter (1999); Barber (2001); Gafner & Benson (2001); Phillips (2001); Lavertue, Kumar & Pekala (2002); Stafrace (2004); McNeal (2007); Chandrashekhar (2016); Gafner (2016); Handel & Néron (2017); Moss & Willmarth (2017); Daitch (2018); and Shenefelt (2018), etc., etc.

The literature also contains many reports of Hartland's published ego-strengthening monologue being successfully applied, precisely as written, to a wide range of complaints: including, for instance, Rose (1967); Basker, Anderson and Dalton (1978); Wakeman and Kaplan (1978); Freeman and Baxby (1982); Gould and Tissler (1984); Finkelstein (1991); Torem (1995); and Spiegel (1996), etc., etc.