The International Journal of Clinical and Experimental Hypnosis 1981, Vol. XXIX, No. 3, 313-323
The Institute of Pennsylvania Hospital and University of Pennsylvania
Abstract: From both theoretical and therapeutic perspectives, there is a need to expand and integrate current lines of research into the phenomenon of self-hypnosis and its clinical application. Some issues and research implications are outlined that concern the need to (a) delineate the phenomenon, (b) convergently assess it through behavioral and phenomenological techniques, and (c) investigate the consequences of its private use. Behavioral, experiential, and consequential measures of self-hypnosis are seen as methodologically distinct ways of convergently assessing the phenomenon. The adoption of multiple strategies of inquiry into the nature and function of self-hypnosis may allow a better understanding of it from the respective viewpoints of those who seek to understand, to teach, and to use the technique.
As well as coining the term "hypnosis," Braid (1846, 1855, cited in Tinterow, 1970) was the first investigator to systematically explore the phenomenon of self-hypnosis. Braid (1846, cited in Tinterow, 1970) used self-hypnosis to aid in his own personal problems and was firmly convinced that
inasmuch as patients can throw themselves into the nervous sleep, and manifest all the usual phenomena of mesmerism, through their own unaided efforts... it is obvious that there is no need for an exotic influence to produce the phenomena of mesmerism [Pp. 358-359].
This viewpoint was supported by a series of demonstrations of individuals experiencing hypnosis and displaying hypnotic phenomena without the direct influence of any other person (see Braid, 1855, cited in Tinterow, 1970).
The investigation of self-hypnosis is important for reasons relating to both clinical application and conceptual clarification. Clinically speaking, relaxation (e.g., Benson & Klipper, 1975), imagery (e.g., Shorr,
Manuscript submitted November 15, 1980; final revision received January 22, 1981.
1 The preparation of this manuscript was supported in part by grant #MH 19156-10 from the National Institute of Mental Health.
2 We are grateful to David F. Dinges, Emily Carota Orne, William H. Putnam, and William M. Waid for their comments during the preparation of the manuscript.3 Reprint requests should be addressed to Martin T. Orne, M.D., Ph.D., Unit for Experimental Psychiatry, 111North 49th Street, Philadelphia, Pennsylvania 19139.
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Sobel, Robin, & Connella, 1980), and self-suggestions (e.g., Andersen & Savary, 1974) have been adopted as important strategies of many current therapies. Each of these strategies is a central component of self- hypnosis, which is currently experiencing wide-spread acceptance as a technique of therapy (see Sheehan & McConkey, 1979). This may be related to the fact that the use of self-hypnosis allows individuals to contribute to their own treatment and to experience a feeling of self-mastery in so doing. That is, when patients who experience problems, such as chronic pain, employ self-hypnosis they generally discover that they can attain mastery over their problem. The knowledge that they themselves can actively intervene in their pain conditions also often leads to dramatic changes in their self-image and their ability to cope as they increasingly realize that their situation is not hopeless. Such a situation may not only facilitate progress but may also be therapeutically beneficial in its own right. The acceptance and use of self-hypnosis may also be related to the feeling of exhilaration often reported to be associated with its initial use, and to the distinct advantages that it has for the therapist when used as a treatment modality.
Data concerning the professional recommendations for the use of self-hypnosis indicate that the majority of clinical psychologists and medical practitioners (who employ hypnosis) teach their patients self-hypnosis (Sheehan & McConkey, 1979), and self-hypnosis is used in most hypnosis treatment programs for smoking (Holroyd, 1980). That is, self-hypnosis is widely used to allow the patient to extend the treatment provided by the therapist. Given the popularity and therapeutic potential of self- hypnosis, further research is desirable to establish a scientific data-base concerning its actual clinical use.
From a theoretical perspective, the investigation of self-hypnosis is important because of its conceptual relationship with hypnosis induced by a hypnotist (i.e., hetero-hypnosis). Research has clearly shown that it is primarily the ability of the individual, rather than the skill of the hypnotist, that determines whether an individual responds to a hypnotic induction (E.R. Hilgard, 1965). On the one hand, since the role of the hypnotist is relatively minor, as compared with an individual's hypnotic aptitude, all hypnosis can be conceived of as self-hypnosis (e.g., Coue, 1922). On the other hand, since self-hypnosis is typically taught in the context of a dyadic relationship, it can be equally well argued that self-hypnosis is simply a variant of hetero-hypnosis (e.g., Weitzenhoffer, 1957). Given the quite different theoretical inferences (and therapeutic procedures) that arise from these alternatives, it is clear that further conceptual analysis and empirical research is needed to clarify the nature of the relationship between self-hypnosis and hetero-hypnosis.
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The present paper seeks to highlight some of the issues that are central to arriving at a complete understanding of the nature and function of self-hypnosis. These issues relate to (a) delineating the phenomenon, (b) indexing it through the use of multiple methods of assessment, and (c) investigating self-hypnosis from the perspective of the individual who uses it. In particular, this paper outlines the need for inquiry into self-hypnosis through the use of behavioral, phenomenological, and consequential indices of self-hypnosis. Although neither one of these approaches is sufficient to define the construct of self-hypnosis, the convergent use of these multiple methods of assessment will hopefully lead to a cross-validation of the phenomenon (see Campbell & Fiske, 1959, and Garner, Hake, & Eriksen, 1956, for further discussion of this approach toward establishing the validity of a psychological construct). That is, the use of these conceptually and methodologically distinct approaches in a convergent fashion will hopefully allow a data-base to emerge that provides a comprehensive view of the phenomenon.
The Delineation of Self-Hypnosis
Any investigation of self-hypnosis invariably needs to take hetero-hypnosis as a conceptual and empirical baseline (Erika Fromm, Brown, Hurt, Oberlander, Boxer, & Pfeifer, 1981). The area of hetero-hypnosis is clearly delineated (e.g., see E.R. Hilgard, 1973; Orne & Hammer, 1974), it lends itself to operational definition and reliable measurement (e.g., see E.R. Hilgard, 1965), and its research methodologies and theoretical models are relatively well developed (e.g., see Erika Fromm & Shor, 1979; Sheehan & Perry, 1976). Hetero-hypnosis is a condition which is indexed by an individual's ability to respond to appropriate suggestions from a hypnotist with alterations of perception and/or memory (Orne, 1977; Orne & Hammer, 1974) that are reflected in his or her behavior. These distinguishing aspects of hetero-hypnosis have been operationally defined and measured in terms of the Stanford scales and their variants (e.g., Weitzenhoffer & E.R. Hilgard, 1962, 1967) and there is considerable consensus about such scales as criterion measures of hetero-hypnotic performance. Such a situation followed from a long evolution of empirical investigation of hetero-hypnosis, however, and a similar evolution has not yet occurred in the area of self-hypnosis, although clear directions for research are emerging.
Most investigators approach the topic of self-hypnosis in terms of their personal conceptions of what the construct means and by relating their particular research or clinical commitments to it. The approaches of current work (e.g., Benson, Arns, & Hoffman, 1981; Fromm et al., 1981; Gardner, 1981; Johnson, 1979, 1981; Ruch, 1975; Sacerdote, 1981; Shor
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& Easton, 1973; Singer & Pope, 1981) reveal something of the range of definitions that have been applied to the area of self-hypnosis as well as the scope and variability of research analysis and clinical practice. In terms of this range of approaches to self-hypnosis, it needs to be stated at the outset that no one approach can be considered to be the correct method of application or investigation. Approaches differ widely, for instance, in the amount of specification that is given to the individual who is to practice self-hypnosis. Fromm et al. (1981) employed subjects who had had a good deal of experience with standard scales of hetero-hypnosis and this prior experience can be said to have set the protocols for their use of self-hypnosis. In parallel fashion, the clinical use of hetero-hypnosis generally sets the protocols for the use of self-hypnosis by patients as a way of refreshing or reinforcing the suggestions given to them by the clinician (see Gardner, 1981; Sacerdote, 1981). On the other hand, some researchers have provided subjects with the barest instructions as to how or what to do during self-hypnosis (see Ruch, 1975) while others have asked subjects to essentially read a full induction procedure to themselves (see Shor & Easton, 1973) which can be said to be similar to listening to an audiotape of another voice. Methodologically speaking, however, when researchers intend to make comparisons between self-hypnosis and any other condition, care should be taken to ensure that the amount of prior and current experience is regulated so that the phenomenological experiences can be appropriately compared. In this regard, the data provided by Fromm et al. (1981) has to be interpreted in light of the fact that subjects' prior experience of hetero-hypnosis and self-hypnosis had not been regulated in any way. Further, the subjects of Fromm et al. (1981) were highly motivated to engage in the study, and future research in self-hypnosis will need to carefully assess both the level and the nature of the motivation underlying the subjects' participation. In fact, differences in response to self-hypnosis and hetero-hypnosis may well be integrally tied to the differential motivations that characterize the individuals attracted to each setting. Such a situation reflects the current state of consensual knowledge about self-hypnosis and points to the need for a range of inquiry modes to investigate the phenomenon.
Pioneering work by Fromm et al. (1981) and others (e.g., Johnson & Weight, 1976; Ruch, 1975; Shor & Easton, 1973) has provided a needed and useful statement of current perspectives concerning self-hypnosis and provided signposts for future research. Findings have indicated that there are important similarities and differences between self-hypnosis and hetero-hypnosis. In both self-hypnosis and hetero-hypnosis, for example, individuals experience a high degree of absorptive involvement and a fading of their generalized reality orientation (Fromm et al.,
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1981), and there is an overall similarity in terms of group behavioral performance (Johnson & Weight, 1976; Ruch, 1975). On the other hand, there appears to be much richer imagery in self-hypnosis (Fromm et al., 1981) and individuals report being more cognitively active and self-controlling than in hetero-hypnosis (Johnson, 1981). Importantly, although the behavioral and experiential responses of subjects to self- hypnosis and hetero-hypnosis are moderately correlated when the tasks are similar, there are individuals who respond quite differently to self-hypnosis and hetero-hypnosis (Fromm et al., 1981; Johnson, 1979, 1981).
The Assessment of Self-Hypnosis
Investigations of hetero-hypnosis have fruitfully progressed in terms of behavioral (e.g., E.R. Hilgard, 1965; McConkey, Sheehan, & Law, 1980) and experiential (e.g., J .R. Hilgard, 1970; Sheehan, McConkey, & Cross, 1978) analyses, although problems exist with both types of approaches. Nevertheless, both approaches have been adopted in current investigations of self-hypnosis. Behaviorally, Shor's (1978) adaptation of a routine tool for assessing hetero-hypnotic performance has been used to index self-hypnotic performance (e.g., Johnson & Weight, 1976; Shor & Easton, 1973). Experientially, the importance of closely analyzing the phenomenology of the hypnotic experience has been demonstrated in the Chicago paradigm (Fromm et al., 1981; Johnson, 1981). Overall, the use of these two basic modes of assessment have begun to delineate the domains of hetero-hypnosis and self-hypnosis both behaviorally and phenomenologically.
Limitations exist with behavioral as well as experiential modes of assessing hetero-hypnosis and self-hypnosis. Most important, perhaps, is that the findings yielded by these approaches may be determined more by the procedures of the assessment than by the nature of the phenomenon. As Johnson (1981) points out, the behavioral approach has tended to emphasize the overall similarity between self-hypnosis and hetero-hypnosis while the experiential approach has tended to emphasize the differences. That is, artifactual influences arising from the methods of comparison may have given rise to more similarities or differences than actually exist.
Artifactual influences can never, of course, be totally eliminated and investigators need to carefully specify the influences that impinge on their subjects. In this respect, the way in which subjects respond to self-hypnosis may be partly determined by the way in which self-hypnosis is represented to them, the specific tasks that they are asked to perform during self-hypnosis, and the mode of assessment selected by the in-
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vestigator to index their performance during self-hypnosis.
In terms of the way in which self-hypnosis is represented to subjects, one possible way of investigating the phenomenon would be to vary the manner in which self-hypnosis is presented to subjects in order to assess the similarities and differences in subjects' responses to these different sets. For instance, self-hypnosis can be legitimately presented to subjects as either skill development, personal growth and enhancement, or development of creative potential; by varying sets such as these in order to examine their differential effects as well as those aspects that remain constant, researchers may come to better understand the nature of the phenomenon. These are not easily explored issues since even the tasks that subjects are asked to perform may help determine their set concerning the process and thus also influence the nature of the findings.
In terms of the tasks that subjects are asked to perform in self-hypnosis and hetero-hypnosis, it needs to be acknowledged that in hetero-hypnosis the tasks are generally well delineated with a specific format and protocol whereas in self-hypnosis the tasks are often relatively open and unspecified. In comparing self-hypnosis and hetero-hypnosis, then, investigators should take care to provide subjects with similar tasks to perform in the different settings. For instance, investigators could appropriately move to study the responses of individuals to self-hypnosis and hetero-hypnosis on both behavioral and experiential dimensions when specific tasks are set for subjects to perform as well as when subjects are simply instructed to experience the condition and not engage in any particular task; that is, analysis of the suggested and nonsuggested aspects of self-hypnosis and hetero-hypnosis may provide important information on their respective natures.
From a clinical perspective, the degree to which a transfer of training of suggested and nonsuggested effects occurs from the therapeutic hetero-hypnotic to the therapeutic self-hypnotic situation is in need of research. For instance, the degree to which subjects or patients who learn to reduce pain in the laboratory or clinic, respectively, can then apply that knowledge in their private environment is an issue in need of careful investigation. In conducting such research, however, the procedures used to index the response are not merely a matter of the investigator's orientation, but in large measure the tasks that subjects are asked to perform will determine the mode of assessment to be employed. For instance, ideomotor responses are easily measured behaviorally, while more cognitive types of responses such as dreams and hallucinations tend to be measured through subjects' reports of their experiences. Similarly, the study of hetero-hypnosis is more easily objectified than is the investigation of self-hypnosis; it will require considerable effort and ingenuity to develop techniques for the behavioral assessment of the
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phenomenological changes that are considered to be the core phenomena of self-hypnosis.
From this perspective, in addition to the desirability of developing reliable scales that behaviorally index subjects' responses to self-hypnosis, measures also need to be refined from the phenomenological approach in order to tap subjects' experiential responses. Rather than considering these in isolation, however, research is needed to determine how measures of behavioral and experiential response during self-hypnosis and hetero-hypnosis interrelate. That is, instead of employing anyone set of assessment procedures, multiple measures and methods of comparison of self-hypnosis and hetero-hypnosis need to be adopted. The convergent application of different strategies of assessment would effectively minimize the procedural artifacts and protect our basic concern for the valid investigation of self-hypnosis. A true understanding of the phenomenon itself is the goal of current research (e.g., Fromm et al., 1981), and it is toward this end that multiple procedures are needed to be systematically applied in the investigation of self-hypnosis.
The Consequences of Self-Hypnosis
While there are many ways in which self-hypnosis can be described, it is most widely perceived as a technique that provides beneficial consequences for the user. That is, along with a wide range of other psychological techniques that are initiated by focused attention self-hypnosis shares the characteristic of reportedly helping an individual derive significant benefits from its use. Despite many clinical anecdotes regarding the benefits of self-hypnosis, there are no systematic data that address the frequency with which it is used and the consequences of such use. There have been relatively few attempts to assess the kinds of changes brought about by an individual's regular use of self-hypnosis. Findings have indicated that when used following instruction from a therapist self-hypnosis is a useful technique in the treatment of anxiety for some individuals (Benson, Frankel, Apfel, Daniels, Schniewind, Nemiah, Sifneos, Crassweller, Greenwood, Kotch, Arns, & Rosner, 1978) and that an individual's confidence in using self-hypnosis increases with practice (Fromm et al., 1981). These data provide useful information and suggest important questions about the use and consequences of self-hypnosis in an individual's private environment.
The beneficial effects of self-hypnosis may be quite different from the kinds of behavioral changes that are typically brought about by specific suggestions given during hetero-hypnosis. That is, the effects of self-hypnosis generally allow the individual to gain control over dysphoric experiences such as pain, feelings of inadequacy, or anxiety. In a true
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sense, these kinds of experiential changes are not only desired by the individual but also appear to involve alterations in experience qualitatively similar to the kind of suggested changes in perception that are used to index hetero-hypnosis (e.g., control of pain and anxiety). In that sense, then, these types of changes might be conceived of as criterion measures uniquely adapted to the phenomenon of self-hypnosis. That is, they involve a desired alteration of experience brought about through self-selected and self-administered suggestions. Since the quality of an individual's response to self-suggestions involves experiential changes analogous to those that are associated with hetero-hypnosis, this suggests the possibility of using the degree and persistence of such changes as indices of self-hypnosis. If such measures were to be taken, however, the influence of the degree to which an individual is motivated and ready for such changes as well as the effect of other relevant individual difference variables (e.g., type and severity of problem) on the therapeutic impact of the technique need to be assessed.
The degree to which self-hypnosis is used by individuals in their own environment, then, may provide a potentially effective way of examining self-hypnosis in its own terms from the perspective of the user. Argument can be made that researchers should allow the phenomenon under scrutiny to determine the assessment procedures, rather than to impose assessment procedures on the phenomenon. From this point of view, it would seem useful to investigate the use of self-hypnosis for different therapeutic problems in terms of both the frequency and consequences of such use on experience. Since individuals trained in self-hypnosis are routinely encouraged to use it to derive benefits at home, for instance, it would be essential to know what they do during the private use of self- hypnosis as well as the nature of the consequences of these activities or the personal meaningfulness of what is being done. That is, self-hypnosis may be investigated by adopting the perspective of those individuals who use it as a means of altering their experiential reality.
The assessment of consequential aspects of self-hypnosis may index the phenomenon in a quite distinct way from that of either behavioral or phenomenological assessment. Further, if the beneficial experiential changes derived from self-hypnosis are adopted as criterion measures, one would want to determine whether behavioral or experiential measures of self-hypnotic responsivity better predict those individuals who derive positive consequences from its use in their private environment. Specifically, research is needed to determine how the level of behavioral and/or experiential responsivity of individuals during self-hypnosis (or hetero-hypnosis) relates to the effective use and desired consequences of self-hypnosis. The determination of whether responsivity on behavioral or experiential dimensions of self-hypnosis or hetero-hypnosis are appreciably related to the consequences of using self-hypnosis may
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also provide an empirical means of predicting some of the successful therapeutic applications of the technique.
In summary, it is suggested that empirically rewarding and conceptually satisfying advances in our knowledge of self-hypnosis can be made if researchers focus on the further development and refinement of performance scales for indexing behavioral responsivity during self-hypnosis and techniques of inquiring into and assessing the phenomenal awareness of individuals experiencing self-hypnosis, as well as on closely analyzing the nature of the phenomenon in an ecologically valid way by indexing the consequences of its use. The findings yielded by these multiple strategies of inquiry will hopefully lead to a fuller understanding and ultimately more effective use of the technique.
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BENSON, H., & KLIPPER, M .Z. The relaxation response. New York: Morrow, 1975.
BRAID, J. The power of the mind over the body. London: John Churchill, 1846. Cited by M.M. Tinterow, Foundations of hypnosis: From Mesmer to Freud. Springfield, Ill.: Charles C Thomas, 1970. Pp. 331-364.
BRAID, J. The physiology of fascination and the critics criticised. Manchester: Grant & Co., 1855. Cited by M.M. Tinterow, Foundations of hypnosis: From Mesmer to Freud. Springfield, Ill.: Charles C Thomas, 1970. Pp. 365-389.
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FROMM, E., BROWN, D.P., HURT, S.W., OBERLANDER, J.Z., BOXER, A.M., & PFEIFER, G. The phenomena and characteristics of self-hypnosis. Int. J. clin. exp. Hypnosis, 1981, 29, 189-246.
FROMM, E., & SHOR, R.E. (Eds.) Hypnosis: Developments in research and new perspectives. (2nd rev. ed.) New York: Aldine, 1979.
GARDNER, G.G. Teaching self-hypnosis to children. Int. J. clin. exp. Hypnosis, 1981,29, 300-312.
GARNER, W.R., HAKE, H. W., & ERIKSEN, C. W. Operationism and the concept of perception. Psychol. Rev., 1956, 63, 149-159.
HILGARD, E.R. Hypnotic susceptibility. New York: Harcourt, Brace & World, 1965.
HILGARD, E.R. The domain of hypnosis: With some comments on alternative paradigms. Amer. Psychol., 1973, 28, 972-982.
HILGARD, J.R. Personality and hypnosis: A study of imaginative involvement. Chicago: University of Chicago Press, 1970.
HOLROYD, J. Hypnosis treatment for smoking: An evaluative review. Int. J. clin. exp. Hypnosis, 1980, 28, 341-357.
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JOHNSON, L.S. Self-hypnosis: Behavioral and phenomenological comparisons with heterohypnosis. Int. J. clin. exp. Hypnosis, 1979, 27, 240-264.
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Abstrakt: Vom Standpunkt der theoretischen sowie therapeutischen Perspektiven besteht die Notwendigkeit, die zur Zeit bestehenden Richtlinien der Forschung zu verbreitern und in das Phanomen del Selbsthypnose und ihrer klinischen Anwendung zu integrieren. Einige dieser Streitfragen und Forschungsimplikationen werden hier umrissen, die sich auf die Notwendigkeit beziehen, (a) das Phanomen zu bezeichnen, (b) es konvergierend durch verhaltensmaBige und phAnomenologische Techniken abzuschatzen und (c) die Konsequenzen ihrer privaten Anwendung zu untersuchen. Behavioristische, experimentelle und konsequente MaBe del Selbsthypnose werden als methodologisch deutliche Wege der konvergierenden Phanomensbeurteilung betrachtet. Die Adoption von mehrfachen Prufungsvorgangen in die Natur und Funktion del Selbsthypnose mag ihr
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besseres Verstehen von den respektiven Standpunkten derer erlauben, die diese Technik zu verstehen, sic zu lehren und anzuwenden suchen.
Resume: Tant du point de vue de la theorie que de la therapie, le besoin se fait sentir d'elargir et d'integrer les lignes actuelles de recherche sur le phenomene de l'auto-hypnose et sur son application clinique. Les auteurs resument quelques problemes et questions de recherche qui indiquent la necessite (a) de delimiter le phenomene, (b) de l'evaluer de facon convergente a l'aide de techniques comportementales et phenomenologiques, et (c) de rechercher les consequences de l'usage personnel de l'auto-hypnose. D'un point de vue methodologique, les mesures comportementales subjectives et resultantes de l'auto-hypnose apparaissent comme des moyens distincts d'evaluer le phenomene de facon convergente. L 'adoption de strategies multiples d'investigation de la nature et de la fonction de l'auto-hypnose peut affiner la comprehension qu'en ont tant celui qui s'interesse a la connaissance pure, que l'enseignant, ou encore celui qui vise l'application de la technique.
Resumen: Tanto desde el punto de vista de la teoria como de la terapia, se hace sentir la necesidad de ampliar y de integrar las lineas actuales de la investigacion sobre el fenomeno de la autohipnosis y de su aplicacion clinica. Los autores resumen algunos problemas y cuestiones vinculadas a la investigacion que muestran la necesidad: (a) de delimitar el fenomeno, (b) de evaluarla de manera convergente, con la ayuda de tecnicas comportamentales y fenomenologicas y (c) de investigar las consecuencias del uso personal de la autohipnosis. Desde un punto de vista metodologico, las medidas comportamentales subjetivas resultantes de la autohipnosis, aparecen como medios distintos pero convergentes, para evaluar el fenomeno. La adopcion de estrategias multiples de investigacion de la naturaleza y de la funcion de la autohipnosis, puede precisar la comprension de quien se interesa ya sea a las ciencias puras, o a la ensenanza o aun de quien se orienta a la aplicacion de la tecnica.