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Flashcards in Erickson Conversational Deck (36):
1

What is a ‘LOST PERFORMATIVE’ (in NLP terms) and how/why might it be used?

LOST PERFORMATIVE: Stating a value judgment without specifying whose judgment it is.

- Its a good thing to wonder.
- Its ok to relax.

Its a good way to embed suggestion in a non-commanding manner, is it not?

2

What is ‘IMPLIED CAUSATIVE’ or ‘IMPLIED LINKS’ and why might one decide to use this language pattern as a tool?

Please give an example of how it might be used.

To connect events/things can inspire one to become a trigger for another.

‘Now, as you sit down on that comfortable chair you can allow those eyes close
and slip into trance.’

Linking behaviour together makes it much more fluid and automatic than seemingly isolated events.

When we learned to drive a car, we learned many bits of isolated behavior. As we grouped them together they became triggers for each other, linked naturally together. By operating trance in this way we can speak to the subconscious more fluidly and effectively.

‘Sit on the chair.’ (((As you )))
‘Allow those eyes to close.’ (((And)))
‘Slip into trance.’

((( * Simplifies and chunks the event . * )))

The chair becomes a trigger.

3

What are ‘truisms’ or ‘stating observable facts’ and why would we use them?

Give an example..

Truisms can be used to embed suggestions and create a ‘yes’ state of mind in which expectancy for something to be true.

4

What is ‘conscious overload’ , ‘pattern interrupt’ and ‘confusion’ in a hypnotic context, and how might they be useful ?


Give an example of how it might be used.

Disrupting normal patterns of thinking can provide fertile ground for change.

When a person is in a state of confusion they are more likely to enter a more passive mindset and be less critical and more open to suggestion.

- Irregularity and surprise captures attention.
- Paul Mckenna uses confusion regularly in his recordings by using sentences which have double tripple meanings and/or unclear joinings.
- Milton Ericksons famous handshake interrupt puts people into a state of shock, which he utilizes by orientating them into trance.
- Flux dislodges the conscious mind and can trigger a state of child-like wonder.
- When we are young everything is new and unusual. Confusion can re-trigger this mindset, with is associated with change and learning.

5

What is ‘Metacommunication’ , in an NLP context?

Give an example of how it may be used.

Communication on a more subtle, indirect and unconscious level. Ie pauses, doubt in voice, gestures, subtle social cues and contexts. Can be used together with all other techniques.

Eg

- I dont know when you will begin to slip into trance (LONG PAUSE).
The pause adds another dimension to the implication that you will slip into trance, implying that it will happen soon. I'm waiting for something to happen!

- If you will begin by sensing the trance as automatic, or feel that you are in control.
Subtle implication that you will feel out of control eventually. This metacommunication might cast doubt on control.

6

OPEN ENDED SUGGESTIONS

What are they and why use them?

OPEN ENDED SUGGESTIONS suggest a response, whilst acknowledging any other response, or lack of response as also being good.

You can hear these words now, enjoy these words, or simply allow them to slip into the back of your mind, as you consider the times you may use this language pattern.

7

What is a ‘bind’ in an NLP context?

Give an example of its use.

A choice between two or more options, all options leading to a favorable direction.

- Would you like to go into trance now or take a moment to become comfortable first?

8

What is a ‘double bind’ in NLP terms?

How does it differ from a standard ‘bind’ ?

Give an example of a double bind might be used.

Like a standard ‘bind’ a ‘double bind’ gives the surface appearance of a simple choice, with both choices being favorable to a certain direction.

A ‘double bind’ is unique in that it implies subconscious or automatic behaviour.

- Do you begin to experience a numbness in the fingers or the back of the hand
first?

9

What is a ‘Double dissociation double bind’ in an NLP context and how can it be useful?

DOUBLE-DISSOCIATION DOUBLE BIND - Double binds which offer two or more alternatives of dissociation. They are valuable as they offer the subconscious the free choice of expression and tend to confuse the conscious mind, whilst encouraging unconscious response.


- You can as a person awaken but you do not need to awaken as a body. (Pause)
You can awaken when your body awakes but without a recognition of your body.


Give another example.

10

What is COMPOUND SUGGESTION?

A compound suggestion is when a suggestion is hitch-hiked onto something else, in order to give it more power.

A basic example of a compound is a truism followed by a suggestion proper.

- Its a common experience to forget a dream, to find it slipping away like sand through fingers and i dont know what your subconscious will choose to share with you when you awaken.

- Pain tends to come and go. For a moment we can forget we are in pain. The pain ceices to exist and your subconscious can surprise you now or in 5 minutes.

- Of course there are people who have suffered anxiety and turned out to have a much greater ability to relax than they knew. They had no special abilities and often its just a matter of letting the unconscious express itself to its full potential. Clearly your subconscious has already altered your rate of breathing, your heart rate has altered. Your unconscious can go on a silent hunt now, for times in the past when you have really enjoyed relaxing. There have been many times in the past of deep comfort and I dont know if you know, that you already possess the ability to deeply relax. Id like you to discover that your subconscious can surprise you in whatever way it chooses.

11

What is a Contingent Suggestion?

A type of compound where a suggestion is hitchhiked on to another response, often already happening, ongoing or inevitable.

-Your eyes will get tired and close all by themselves as you continue looking at that
spot.
(The implication of going into trance is hitchhiked onto the natural response of the eyes to become tired when in intense focus)

-You will find yourself becoming more relaxed and comfortable as you continue
sitting there with your eyes closed.
(Implication of going into trance is hitchhiked onto natural response of relaxation when sitting with eyes closed)

12

Give an example of where distraction might be used in trance.

Dr Milton Erickson often used distraction techniques post-trance, to prevent conscious interference.

It is speculated that there is a 5 minute in-between period after a person has formally awoken from trance.

When distraction is used to stop the conscious mind 'playing around in the grey area' it creates a better trance/wake distinction (facilitating amnesia etc) & helps to prevent framework limits from interfering with the trance work.

Maybe like when we wake up in the morning after having a dream - if we make an effort to remember the dream immediately after awakening, we can normally hold onto the dream and remember parts or all of it. If we are distracted,we tend to forget it.

13

Where can questions be used in trance and what makes them so useful?

Explain some of their uses.

One of the most surprising aspects of Milton Ericksons approach is his use of questions to focus attention, to suggest indirectly, and to reinforce all at the same time.

Must be careful since questions can be detrimental ie when they are intrusive.

Studies show that the unconscious mind continues a search related to the question long after the conscious mind is satisfied and focussed elsewhere.

14

Whats the ‘magic’ behind the scenes in Dr Milton Ericksons famous ‘HANDSHAKE INDUCTION’?

Dr Erickson would sometimes strategically move his fingers whilst shaking a persons hand, before bringing their hand to the air, or gently leaving it in an un-natural position.

This would -
Confuse
Overwhelm

A state of confusion can encourage trance.

15

Why might one be mindful of rhythm when inducing trance?

RHYTHMS –
Rhythms and atypical grammar tend to be powerful trance inducers. Music, poetry and other common trance inducers tend to use rhythms. Dr Milton Erickson commonly used irregular rhythm and atypical grammar.

One very effective away to establish report is by matching your rhythms with patients - ie breathing , or mirroring their own rhythms back to them in different ways (ie subtly tap finger every time they breath out).

16

What is LACK OF REFERENTIAL INDEX (NLP term) and how might it be used in hypnotic communication?

A phrase that has deleted or generalized the subject in question.

Eg
"One can be curious","A person can learn."

This can be a good way to suggest indirectly and was a method of speach often used by Dr Milton Erickson.

17

What is a COMPARATIVE DELETION (NLP term) and how may it be useful?

COMPARATIVE DELETION –
A phrase offering a comparison, but omitting the object being compared.

Eg
"You can learn even more."


This vague way of communicating can be useful by offering freedom of interpretation, allowing the subject to decipher it in the way most appropriate and/or useful to them.

This is a type of deletion - a phenomena where unspecific or generalized phrases are used , often seeming more specific than they are. Deletions are often used in things like horoscopes eg ‘The feeling is easing and you can sense a new horizon opening up in your life.’ This sentence can sound very personal.

18

How did Milton Erickson often make reference to ‘not knowing’ or ‘not doing’ ?

Why might this be useful for strengthening trance?

NOT KNOWING / NOT DOING –


Eg "And you don't even need to think about going deep into trance." "No need to make any effort.. To remember to use this technique in trance.. or imagine doing so.. but to simply enjoy.. idol moments of play with this pattern.. not knowing.. how you learn.. so effortlessly , in this way .”

19

Attention fixation is the most important property of trance.

Give some examples of how attention can be captured.

1. Stories
which
motivate
interest,
fascination ,
etc.
2. Standard
eye fixation
3. Approaches
by
pantomime
4. Approaches
determined by
the
imagination
and
visualization
5. Levitation
of the hand
6. Relaxation
and all forms
of experience
emotional
7. Confusion / shock / surprise

20

Give examples of techniques one might use to diminish the
potential of the
conscious to disrupt trance and impose learned limits?

1. Shock, surprise,
the unreal and the
unusual.
2. Reference frame
change.
3. Distraction .
4. Dissociation and
unbalance .
5. Cognitive
saturation.
6. Confusion, non
sequitur.

21

Why might the therapist have used the following phrase -

“José, all of us human beings (José) have own resources (José) to solve problems (José) “

- Initiate subconscious on an inner search.

- Name tagging can help to fixate attention.

- Focus on motivation (what problem would i like solved?). Focussing on a motivation strengthens it and fuels unconscious search for solution.

- Indirect suggestion, presented in a non-opposing manner. Find solutions!

22

DELETION

‘A person can relax and simply enjoy learning the tendencies, of hypnotic communication. Thats right.’

Whats been deleted from this sentence?

Who- who can relax? me?
When - when can they relax? now?
Thats right - whats right?

Deletions allow communication to be interpreted in a flexible and subjective way, whilst often seeming specific on a surface level.

23

In 1976 Erickson and Rossi described the power of what has now been coined a ‘double dissociation double bind’.

What is it and why did Erickson find it useful?

A double bind suggests the choice between two subconscious or irregular outcomes.

Described by Ericsson and Rossi in 1976, it confuses the conscious mind and
depotentiates its referential frames, erroneous ideas and learned limits to facilitate
unconscious searches of new resources for behavior changes.


“Now in a moment, memories will appear but you can forget them as they are
appearing… (pause)… or you can remember important facts that will help you and
not know that you had remembered them before”.

“Now you can close your eyes and experience them as being heavier than normal, or you can experience their weight as normal, yet sense the beginning of a flutter.”

“You can be in trance and recognize that trance or not know you are in trance but simply be curious of the unusual sensations, when you are reading these words.”



24

What did Zeigarnik observe in 1927?

NOTE: Bluma Wulfovna Zeigarnik (1900-1988) psychologist and soviet psychiatrist
(Prienai) stated that “the persons tend to better recall the incomplete chores, or the
interrupted ones than those that have already finished”. In 1927 she published a research
paper related to this: she gave a group of subjects a set of 18 to 21 successive chores
(enigmas, mathematical problems, poems, etc.). Half were interrupted before they had been finished. The interrupted chores were better recorded, while the rest were ignored or less recalled.

25

What is ‘reframing’ and how did Erickson often use this technique?

Reframing is to offer a new way of looking at something.

‘It can be wonderful to look back at times of depression and understand how they can help us deepen our connection to others. ‘

‘I once met a man who was lucky enough to suffer from tremors, just like yours and as those tremors began to ease, he had even more appreciation of the enjoyment of being tremor-free.’

‘You seem nervous. Great! Its always nice when someone is anxious to get started and you probably want to go into trance right now, don’t you? Sometimes people tend to wait around too much - but i can see you are excited to get started!!)

26

Why can crisis and chaos be an opportunity?

Crisis can provide a powerful motivation for change and a state of un-certainty can be fertile ground for introducing new patterns/viewpoints.

27

One of the most striking things about Dr Milton Erickson was his tendency to communicate via use of ...

M*T****R

Metaphor!

Milton Erickson would often speak in Metaphor, in order to capture the attention and focus the mind in helpful ways.

‘A story can be a black hole, and you never know exactly where in the universe it may transport you. Stories can change and inspire, focus and motivate.’

28

What is an anchor and how may it be used?

An anchor is a word used to describe the tendency for certain stimulus to trigger inner movement.

For example someone with a phobia of elevators has certain negative feelings/images/ anchored with the sight of an elevator. It is the hypnotists job to help replace those anchors.

Creating an ‘anchor’ is the act of linking one behavior and/or stimulus to another.

Ie tap hand on table every time a patient laughs. That tap then becomes associated with the feeling of ‘laughter’. It can then be used to associate a laugh with a phobia, for example, which can help to remove the power of fear.

29

Imagine you are watching a video of Milton Erickson hypnotising and you notice he’s moving his head from side to side.

Why might he be doing this?

- To confuse and create irregular experience.
- Rhythm can aid trance.
- He might be pacing the clients breathing or another pattern.
- He might be embedding suggestions, or using the movements as markers for sub-communication. Eg he moves his head to left when he gives the suggestion too.. remember this as its useful!

He once bobbed his head left and right whilst suggesting sea-sickness to a patient with his eyes closed.

30

According to Edgar A Etkin , DEFENSE MECHANISMS (forms of maintaining the balance) -


1 - REPRESION (to avoid reality)
2 - PROJECTION (to alleviate guilt taking tension away)
3 - DISSOCIATION (an object that can be good or bad)
4 - ISOLATION (to satisfy pulsions in a virtual way)
5 - SUBSTITUTION (to change a situation or person for a more acceptable one.
Example: The boss reprimands him and then he ill-treats his wife)
6 - SUBLIMATION (negative pulsion changes into social values)
7 - RATIONALIZATION (to justify errors)
8 - NEGATION (to deny real or painful imagined aspects)
9 - FANTASY (creation of worlds of one’s own with consensus)
10 - DISPLACEMENT (to transfer negative impulses on other persons or objects.
Example: a child that sucks his thumb when a brother is born)
11 - REGRESSION (to assume a childish position to obtain benefits)
12 - COMPENSATION (to compensate limits with other actions)

22 –DEFENSE MECHANISMS (forms of maintaining the balance)
1 - REPRESSION (to avoid reality)
2 - PROJECTION (to alleviate guilt taking tension away)
3 - DISSOCIATION (an object that can be good or bad)
4 - ISOLATION (to satisfy pulsions in a virtual way)
5 - SUBSTITUTION (to change a situation or person for a more acceptable one.
Example: The boss reprimands him and then he ill-treats his wife)
6 - SUBLIMATION (negative pulsion changes into social values)
7 - RATIONALIZATION (to justify errors)
8 - NEGATION (to deny real or painful imagined aspects)
9 - FANTASY (creation of worlds of one’s own with consensus)
10 - DISPLACEMENT (to transfer negative impulses on other persons or objects.
Example: a child that sucks his thumb when a brother is born)
11 - REGRESSION (to assume a childish position to obtain benefits)
12 - COMPENSATION (to compensate limits with other actions)

31

According to Edgar A Etkin , DEFENSE MECHANISMS (forms of maintaining the balance) -


1 - REPRESION (to avoid reality)
2 - ********* (to alleviate guilt taking ****** away)
3 - DISSOCIATION (an object that can be good or bad)
4 - ISOLATION (to satisfy pulsions in a virtual way)
5 - SUBSTITUTION (to change a situation or person for a more acceptable one.
Example: The boss reprimands him and then he ill-treats his wife)
6 - SUBLIMATION (negative pulsion changes into social values)
7 - RATIONALIZATION (to justify errors)
8 - NEGATION (to deny real or painful imagined aspects)
9 - FANTASY (creation of worlds of one’s own with consensus)
10 - DISPLACEMENT (to transfer negative impulses on other persons or objects.
Example: a child that sucks his thumb when a brother is born)
11 - REGRESSION (to assume a childish position to obtain benefits)
12 - COMPENSATION (to compensate limits with other actions)

According to Edgar A Etkin , DEFENSE MECHANISMS (forms of maintaining the balance) -


1 - REPRESION (to avoid reality)
2 - PROJECTION (to alleviate guilt taking tension away)
3 - DISSOCIATION (an object that can be good or bad)
4 - ISOLATION (to satisfy pulsions in a virtual way)
5 - SUBSTITUTION (to change a situation or person for a more acceptable one.
Example: The boss reprimands him and then he ill-treats his wife)
6 - SUBLIMATION (negative pulsion changes into social values)
7 - RATIONALIZATION (to justify errors)
8 - NEGATION (to deny real or painful imagined aspects)
9 - FANTASY (creation of worlds of one’s own with consensus)
10 - DISPLACEMENT (to transfer negative impulses on other persons or objects.
Example: a child that sucks his thumb when a brother is born)
11 - REGRESSION (to assume a childish position to obtain benefits)
12 - COMPENSATION (to compensate limits with other actions)

32

According to Edgar A Etkin , DEFENSE MECHANISMS (forms of maintaining the balance) -


1 - REPRESION (to avoid reality)
2 - PROJECTION (to alleviate guilt taking tension away)
3 - ********** (To ****** ourself from a matter.)
4 - ISOLATION (to satisfy pulsions in a virtual way)
5 - SUBSTITUTION (to change a situation or person for a more acceptable one.
Example: The boss reprimands him and then he ill-treats his wife)
6 - SUBLIMATION (negative pulsion changes into social values)
7 - RATIONALIZATION (to justify errors)
8 - NEGATION (to deny real or painful imagined aspects)
9 - FANTASY (creation of worlds of one’s own with consensus)
10 - DISPLACEMENT (to transfer negative impulses on other persons or objects.
Example: a child that sucks his thumb when a brother is born)
11 - REGRESSION (to assume a childish position to obtain benefits)
12 - COMPENSATION (to compensate limits with other actions)

According to Edgar A Etkin , DEFENSE MECHANISMS (forms of maintaining the balance) -


1 - REPRESION (to avoid reality)
2 - PROJECTION (to alleviate guilt taking tension away)
3 - DISSOCIATION (To detach ourself from a matter.)
4 - ISOLATION (to satisfy pulsions in a virtual way)
5 - SUBSTITUTION (to change a situation or person for a more acceptable one.
Example: The boss reprimands him and then he ill-treats his wife)
6 - SUBLIMATION (negative pulsion changes into social values)
7 - RATIONALIZATION (to justify errors)
8 - NEGATION (to deny real or painful imagined aspects)
9 - FANTASY (creation of worlds of one’s own with consensus)
10 - DISPLACEMENT (to transfer negative impulses on other persons or objects.
Example: a child that sucks his thumb when a brother is born)
11 - REGRESSION (to assume a childish position to obtain benefits)
12 - COMPENSATION (to compensate limits with other actions)

33

According to Edgar A Etkin , DEFENSE MECHANISMS (forms of maintaining the balance) -


1 - REPRESION (to avoid reality)
2 - PROJECTION (to alleviate guilt taking tension away)
3 - DISSOCIATION (To detach ourself from a matter.)
4 - ISOLATION (to satisfy pulsions in a virtual way)
5 - SUBSTITUTION (to change a situation or person for a more acceptable one.
Example: The boss reprimands him and then he ill-treats his wife)
6 - SUBLIMATION (negative pulsion changes into social values)
7 - RATIONALIZATION (to justify errors)
8 - NEGATION (to deny real or painful imagined aspects)
9 - ******* (creation of worlds of one’s own with consensus)
10 - DISPLACEMENT (to transfer negative impulses on other persons or objects.
Example: a child that sucks his thumb when a brother is born)
11 - REGRESSION (to assume a childish position to obtain benefits)
12 - COMPENSATION (to compensate limits with other actions)

According to Edgar A Etkin , DEFENSE MECHANISMS (forms of maintaining the balance) -


1 - REPRESION (to avoid reality)
2 - PROJECTION (to alleviate guilt taking tension away)
3 - DISSOCIATION (To detach ourself from a matter.)
4 - ISOLATION (to satisfy pulsions in a virtual way)
5 - SUBSTITUTION (to change a situation or person for a more acceptable one.
Example: The boss reprimands him and then he ill-treats his wife)
6 - SUBLIMATION (negative pulsion changes into social values)
7 - RATIONALIZATION (to justify errors)
8 - NEGATION (to deny real or painful imagined aspects)
9 - FANTASY (creation of worlds of one’s own with consensus)
10 - DISPLACEMENT (to transfer negative impulses on other persons or objects.
Example: a child that sucks his thumb when a brother is born)
11 - REGRESSION (to assume a childish position to obtain benefits)
12 - COMPENSATION (to compensate limits with other actions)

34

According to Edgar A Etkin , DEFENSE MECHANISMS (forms of maintaining the balance) -


1 - REPRESION (to avoid reality)
2 - PROJECTION (to alleviate guilt taking tension away)
3 - DISSOCIATION (To detach ourself from a matter.)
4 - ISOLATION (to satisfy pulsions in a virtual way)
5 - SUBSTITUTION (to change a situation or person for a more acceptable one.
Example: The boss reprimands him and then he ill-treats his wife)
6 - SUBLIMATION (negative pulsion changes into social values)
7 - RATIONALIZATION (to justify errors)
8 - NEGATION (to deny real or painful imagined aspects)
9 - FANTASY (creation of worlds of one’s own with consensus)
10 - DISPLACEMENT (to transfer negative impulses on other persons or objects.
Example: a child that sucks his thumb when a brother is born)
11 - ********* (to assume a childish position to obtain benefits)
12 - COMPENSATION (to compensate limits with other actions)

According to Edgar A Etkin , DEFENSE MECHANISMS (forms of maintaining the balance) -


1 - REPRESION (to avoid reality)
2 - PROJECTION (to alleviate guilt taking tension away)
3 - DISSOCIATION (To detach ourself from a matter.)
4 - ISOLATION (to satisfy pulsions in a virtual way)
5 - SUBSTITUTION (to change a situation or person for a more acceptable one.
Example: The boss reprimands him and then he ill-treats his wife)
6 - SUBLIMATION (negative pulsion changes into social values)
7 - RATIONALIZATION (to justify errors)
8 - NEGATION (to deny real or painful imagined aspects)
9 - FANTASY (creation of worlds of one’s own with consensus)
10 - DISPLACEMENT (to transfer negative impulses on other persons or objects.
Example: a child that sucks his thumb when a brother is born)
11 - REGRESSION (to assume a childish position to obtain benefits)
12 - COMPENSATION (to compensate limits with other actions)

35

According to Edgar A Etkin , DEFENSE MECHANISMS (forms of maintaining the balance) -


1 - REPRESION (to avoid reality)
2 - PROJECTION (to alleviate guilt taking tension away)
3 - DISSOCIATION (To detach ourself from a matter.)
4 - ISOLATION (to satisfy pulsions in a virtual way)
5 - SUBSTITUTION (to change a situation or person for a more acceptable one.
Example: The boss reprimands him and then he ill-treats his wife)
6 - SUBLIMATION (negative pulsion changes into social values)
7 - RATIONALIZATION (to justify errors)
8 - ******** (to deny real or painful imagined aspects)
9 - FANTASY (creation of worlds of one’s own with consensus)
10 - DISPLACEMENT (to transfer negative impulses on other persons or objects.
Example: a child that sucks his thumb when a brother is born)
11 - REGRESSION (to assume a childish position to obtain benefits)
12 - COMPENSATION (to compensate limits with other actions)

According to Edgar A Etkin , DEFENSE MECHANISMS (forms of maintaining the balance) -


1 - REPRESION (to avoid reality)
2 - PROJECTION (to alleviate guilt taking tension away)
3 - DISSOCIATION (To detach ourself from a matter.)
4 - ISOLATION (to satisfy pulsions in a virtual way)
5 - SUBSTITUTION (to change a situation or person for a more acceptable one.
Example: The boss reprimands him and then he ill-treats his wife)
6 - SUBLIMATION (negative pulsion changes into social values)
7 - RATIONALIZATION (to justify errors)
8 - NEGATION (to deny real or painful imagined aspects)
9 - FANTASY (creation of worlds of one’s own with consensus)
10 - DISPLACEMENT (to transfer negative impulses on other persons or objects.
Example: a child that sucks his thumb when a brother is born)
11 - REGRESSION (to assume a childish position to obtain benefits)
12 - COMPENSATION (to compensate limits with other actions)

36

The principle of is a pivotal aspect of Dr Ericksons work.

“ Ordinarily , trance induction is based upon securing from the patients some form of initial acceptance and cooperation with the operator. In ‘techniques of utilization’ the usual procedure is reversed to an initial acceptance of te patients’ presenting behaviors and ready cooperation by the operator however seemingly adverse the presenting behavior may appear to be in the clinical situation.

The principle of utilization is a pivotal aspect of Dr Ericksons work.

“ Ordinarily , trance induction is based upon securing from the patients some form of initial acceptance and cooperation with the operator. In ‘techniques of utilization’ the usual procedure is reversed to an initial acceptance of te patients’ presenting behaviors and ready cooperation by the operator however seemingly adverse the presenting behavior may appear to be in the clinical situation.