5. A Retrospective on C.R.E.A.M.
“The fox knows many things, but the hedgehog knows one big thing.” — Archilochus
This was a short, five year retrospective on a way of thinking about hypnosis that appealed to me once upon a time and was first posted on reddit. Given this would be the fifth post on the blog, I thought it rhymed.
C.R.E.A.M. was carved out of a biopsychosocial model of the factors that influence hypnotic response1 Jensen, M. P., Adachi, T., Tomé-Pires, C., Lee, J., Osman, Z. J., & Miró, J. (2015). Mechanisms of hypnosis: toward the development of a biopsychosocial model. International Journal of Clinical and Experimental Hypnosis, 63(1), 34-75. https://www.tandfonline.com/doi/abs/10.1080/00207144.2014.961875 . It principally focused on the factors of the model summarized in the diagram above that we as hypnotists could reasonably control and narrowed the factors down to five:
- Context
- Rapport
- Expectation
- Absorption
- Motivation
Five years later, I still quite like the framework as a pedagogical tool. I certainly could have done worse; I have had a few doubts along those years though. The first was on the construct of “rapport” and how I saw it used. A lot of the rapport building techniques prioritize being in sync, being congruent and matching the subject2 You will like me, because I am like you! . And I think this kind of rapport that is imitative in nature is a perfectly fine way to do things. But I think there’s also a complementary kind of rapport. The kind we see in more dominant and authoritative styles. The hypnotist doesn’t try to mirror and match as much as they present themselves as a person of authority3 Look at the diplomas on the wall, my tuxedo, my stage, my camera man, my whips and floggers - I am a professional, don’t you know? and gives space for the subject to conform. I think this is also a fine way to do things. Both have their drawbacks, which become obvious when taken to comical extremes - the first hypnotist lacks a sense of identity, boundaries, and is whatever the subject wants them to be while the other inspires fear, resistance, and is a bit of an asshole. Most people, I thought then, fall somewhere in that spectrum in their approach to the relationship they build with the subject. It feels weird to call the second style rapport, so I thought I would call it connection and collapse rapport and motivation into it for the sake of parsimony. And I rephrased the acronym to be Expectation, Premise, Immersion, and Connection.
Which was E.P.I.C.
Thinking about connection made more room for emotion than “motivation” as a word could inspire in me. And the more I did things and thought things through, the emotional salience, the meaningfulness of what we were doing seemed to matter more and more, both in a philosophical sense and in a practical matter of results. At some point, I came across Kev Sheldrake4 /u/hypnokev and Anthony Jacquin’s old Head Hacking material and one of their hypotheses stood out to me. Engaging people emotionally increased hypnotic response, and it wasn’t just me, I wasn’t seeing things or at least, I wasn’t the only one seeing things.
And the more I thought of it, depth of engagement seemed more fundamental than depth of trance or absorption or immersion5 Depth is such a delightfully flexible word, isn’t it? . The way people engaged with their emotions and expectations seemed to be more predictive and philosophically parsimonious. And so I took the carving knife back to the acronym to simplify it even further6 The primary criticism about C.R.E.A.M. I remember getting, was it was too jargony. and got it down to the 3Es:
- E – Emotion (Motivation+Rapport)
- E – Expectation (Context+Expectation)
- E – Engagement (Absorption+Rapport)
Here, I folded in Context into Expectation to help reinforce the role of demand characteristics and the expectations implied by and inherent to contexts. I foresee that kind of sensemaking becoming more central in the way we think about suggestions and how to pre-suade people of them as Cialdini might say. Rapport, I cleaved into half, one half that described the feelings of alliance and power dynamic and taken along with Motivation to make Emotion. The other half, was the part that related to attunement and interpersonal synchrony and that mixed with absorption and immersion, I could make up the factor of Engagement.
I think7 As of writing this. the 3Es are the three fundamental pillars of the way I do hypnosis, and perhaps, the way everyone else does it too. I still think of things in terms of C.R.E.A.M. from time to time, when I am debugging some sort of a response, but I am much more aware of the importance of engaging people’s emotions and expectations. This is also of course, not the only way of looking at things, my post on C.R.E.A.M. here got riffed on beautifully by /u/randomhypnosisacct in his newbie guide as :
I think there is more to be said about each of these components. In a way, they are the salt, fat, acid, and heat of the hypnotic interaction. In psychotherapy, there is an argument (made most persuasively by Wampold (2015)) that Common Factors like Alliance and Empathy (similar to Rapport), Goal Consensus and Positive Regard (similar to Motivation), and Expectation make most of the difference in outcomes over specific ingredients. And I think in hypnotic contexts, the same is true. The common factors have been, in my experience, more important than the special techniques and secret ingredients that are oh so famous.