The Hypnotic Ego-Strengthening Procedure, incorporating its constituent, influential hypnotherapeutic monologue which delivered an incremental sequence of both suggestions for within-hypnotic influence and suggestions for post-hypnotic influence was developed and promoted by the British consultant psychiatrist, John Heywood Hartland (1901–1977) in the 1960s.
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);Waxman, 1989, p 218; Heap & Aravind, 2001, p. 126; Yeates, 2016c, p 68; Moss & Willmarth, 2017, p. 126. and Hartland's constituent ego-strengthening monologueNamely, Hartland 1965, p. 91; 1966, pp. 191-192; 1967, pp. 216-218; 1971b, pp. 199-202; 1971c, pp. 4-7; Waxman, 1989, pp. 219-223); and Heap & Aravind (2001, pp. 127-128). See also: Yeates, 2002; and 2014b. was entirely based upon the "curative suggestion" monologue component of Coué's method.See: Coué, 1922b, pp. 19-23; and Coué & Orton, 1924, pp. 80-88.
Hartland used his procedure to (pre-therapeutically) strengthen his patients' inner resources"The true therapeutic value of hypnosis lies in the suggestions made during it." (Freud, 1891/1966, p. 111) "designed to remove tension, anxiety and apprehension, and to gradually restore the patient's confidence in himself and his ability to cope with his problems",Hartland, 1971b, p.196. and "analogous to the medical setting in which a patient is first strengthened by proper nutrition, general rest, and weight gain before a radical form of surgery is performed"Torem, 1990, p. 110.; Torem continues: "In my opinion, ego-strengthening is a technique that is indicated for all patients who come to us looking for an alleviation of their suffering regardless of what their symptoms are. It is like saying that healthy and good nutrition is helpful to all patients regardless of what their diagnosis or illness is." (loc. cit.) and, specifically, the procedure was intended to enhance the therapeutic efficacy of his (subsequent) symptom-removal hypnotherapy. 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."In my own psychiatric practice some 70% of my patients recover as a result of the "ego-strengthening" technique alone, usually well within Wolberg's suggested limit of 20 sessions of short-term psychotherapy". (Hartland, 1971c, p. 8)
Hartland's 1965 article, "The Value of "Ego-Strengthening" Procedures Prior to Direct Symptom-Removal under Hypnosis" was significant for positioning the concept of "ego-strengthening" in the hypnotherapeutic literature;"Ego strengthening [is] the bedrock upon which [most] other [hypno-analytical] techniques are structured” (McNeal and Frederick, 1993, p. 170). and "ever since then, the concept could be unequivocally named, identified, investigated, productively discussed, and generally understood by all concerned".Yeates (2014a), p.4. In addition to providing his monologue's full text, Hartland's article was also significant for introducing the convention of ". . ." to indicate pauses in the operator's delivery. "Ego-strengthening suggestions are designed to increase the patient's ability to cope with his difficulties or to encourage him to stand on his own feet. There are three kinds of ego-strengthening suggestions: (a) general ego-strengthening suggestions, (b) specific ego-strengthening suggestions to facilitate the discovery and enhancement of the patient's inner coping strategies, and (c) specific suggestions to foster the patient's sense of self-efficacy. ... Ego-strengthening suggestions, while seemingly simplistic, are quite valuable. Hartland and many others believe that in certain instances ego-strengthening suggestions alone can bring about a successful treatment outcome without [any need to resort to either] symptomatic or dynamic hypnotherapy. Some patients experience spontaneous alleviation of symptoms when they feel strong enough to cope without the symptoms. Direct suggestions for coping, therefore, are sometimes more effective than direct suggestions for symptom change." Brown & Fromm (1986, pp. 194, 195). "Ego strengthening began as a specific strategy for hypnotic interventions and evolved into an attitude pervading psychotherapy and clinical hypnotic work. ... Students in hypnosis training should be introduced to an ego strengthening attitude for clinical work, and master specific therapeutic interventions to induce ego strengthening. Such interventions may include guided imagery for self-acceptance and self-love, affirming language that counteracts negative self-talk, age regression to recapture forgotten strengths, and age progression to anticipate and imagine future wisdom and strengths." Moss, Willmarth & Reid (2024, p. 831).
Emile Coué and la méthode Coué
The insights, observations, technical developments, and procedural innovations of Émile Coué, the French scientist,"[Coué] could read Latin, spoke fluent German and English, and had both B.A. and B.Sc. degrees before he was 21" (Yeates, 2016a, p. 6). 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.Yeates, 2016a, 2016b, 2016c.According to David Cheek and Leslie LeCron, "Coué made a study of suggestion and learned much about it and how to use it most effectively. Much of our current knowledge of this subject stems from Coué's observations". (Cheek & LeCron, 1968, p. 60; emphasis added to original)For the francophone world, see Guillemain (2010), Westphal & Laxenaire (2012), etc. "Coué’s method was disarmingly non-complex—needing few instructions for on-going competence, based on rational principles, easily understood, demanding no intellectual sophistication, simply explained, simply taught, performed in private, using a subject's own resources, requiring no elaborate preparation, and no expenditure."Yeates, 2016a, p. 8. "Most of us are so accustomed ... to an elaborate medical ritual ... in the treatment of our ills ... [that] anything so simple as Coué's autosuggestion is inclined to arouse misgivings, antagonism and a feeling of scepticism."Duckworth 1922, pp. 3–4. "Continuously, unjustly, and mistakenly trivialised as just a hand-clasp, some unwarranted optimism, and a 'mantra', Coué's method evolved over several decades of meticulous observation, theoretical speculation, in-the-field testing, incremental adjustment, and step-by-step transformation. It tentatively began (c.1901) with very directive one-to-one hypnotic interventions, based upon the approaches and techniques that Coué had acquired from an American correspondence course. As his theoretical knowledge, clinical experience, understanding of suggestion and autosuggestion, and hypnotic skills expanded, it gradually developed into its final subject-centred version—an intricate complex of (group) education, (group) hypnotherapy, (group) ego-strengthening, and (group) training in self-suggested pain control; and, following instruction in performing the prescribed self-administration ritual, the twice daily intentional and deliberate (individual) application of its unique formula, "Every day, in every way, I'm getting better and better".Yeates, 2016c, p. 55.
Apothecary 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",Yeates, 2016a, p. 6. 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. He then "spent six months as a pharmaceutical intern at Paris's Necker Hospital", before returning to Troyes in 1883 to take over the operation of the town's largest apothecary (a different one from the one to which he had been apprenticed), where he "constantly interacted with people who were, often, extremely sick, involving consultations, diagnosis and prescription, appraisal of treatment efficacy, deciding next treatment, etc."Yeates, 2016a, p. 7.
Liébeault and "Suggestive Therapeutics"
In 1885, Coué's father-in law, the eminent French horticulturist Victor Lemoine, introduced him to Ambroise-Auguste Liébeault,See: Gauld, (1992), pp. 319-324; Carrer (2002). a medical practitioner in nearby Nancy, France. Liébeault, who had earlier dabbled with animal magnetism, and who, now, promoted what he termed "suggestive therapeutics" i.e., "an imperfect re-branding of the 'dominant idea' theory that James Braid had appropriated from [his Edinburgh teacher,] Thomas Brown" (Yeates, 2016a, p. 12)See: Brown (1851), and Yeates (2005); Braid (1843), Carpenter (1852), Carpenter (1853), Braid (1855, p. 852), and Carpenter (1874); Bramwell (1897a), and Bramwell (1897b); Bernheim (1897), and Bramwell (1898).Also see Bramwell's "Points of Difference between Braid and the Nancy School as to Suggestion", at pp. 338-339 of Bramwell (1903). that was centred, in part, on an extended, laborious, monotonous, "sleep, sleep, sleep" induction of "hypnosis", and the consequent state of "charme" (i.e., "spellbound") that it produced.
Greatly impressed, Coué employed a manager for his pharmacy, moved to Nancy, and studied with Liébeault in 1885 and 1886.Baudouin, 1920, p. 13. Coué returned to Troyes in 1886, and resumed the management of his pharmacy (which had declined in his absence). Thoroughly convinced of the value of Liébeault's theoretical position ("suggestive therapeutics"), "on the potential that changes in [a subject's] mind-set offered for relief, amelioration, and cure",Yeates, 2016c, p. 67) Coué began to experiment with Liébeault's "hypnosis" procedure with his Nancy clientele.Yeates, 2016a, p.12; 2016c, pp. 56-57. Having soon discovered that Liébeault's techniques were hopeless in practice, he abandoned both Liébeault's "sleep"-based "hypnosis" and hypnotherapy altogether.By (at least) 1913, Coué was observing that Liébeault had been vague, imprecise, and "lacked method" (Baudouin, 1923, pp.18-21); and, further (in 1926) was remarking that, whilst, "in many cases, [Liébeault] got good effects ... he lacked a theoretically correct method, [and, as a consequence,] worked blindly” (Coué, 1926, p.21).
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