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Presenting Hypnosis to Patients© Maureen F. Turner, RNBC, LCMHC, LCSW Co-Director, Hypnovations: Clinical Hypnosis Training and Education Programs April 9, 2009 Some Uses for Hypnosis www.motivationhypnosis.com ADD/ADHD Allergies Anxiety Attention Concentration Confidence Co-operation Compliance Diet Empowerment Exercise Fear Focus Habit Control Healing Infertility Insomnia Memory Pain Control Panic Performance Prosperity Some Uses for Hypnosis (P.2) Regression Relationships Self Esteem Sleep Smoking Sports Performance Study Skills Test Anxiety Weight Control Worry Presenting Hypnosis to Patients Components to Include PHASE 1. EVALUATION PHASE 2. EDUCATION PHASE 3. HISTORY TAKING FOR HYPNOSIS PHASE 4. ASSESSMENT OF HYPNOTIZABILITY PHASE 5.TEACHING SELF HYPNOSIS PRESENTING HYPNOSIS TO THE PATIENT WHO IS: 1. A CURRENT PATIENT/CLIENT 2. A NEW PATIENT/CLIENT ESTABLISHING THE HYPNOTIC RELATIONSHIP PHASE 1. EVALUATION a. Current patient/client ► Clinician - Evaluate applicability of hypnosis in reaching clinical goals. ► Clinician - Plan presentation to patient/client option of hypnosis as an aid or vehicle to achieve goals. ► Clinician – Introducing the option of hypnosis- answering questions, assessing and responding to beliefs and fears. ESTABLISHING THE HYPNOTIC RELATIONSHIP PHASE 1. EVALUATION (Continued) b. New patient/client requesting Clinical Hypnosis treatment ► Evaluating appropriateness (often starting with initial phone call) ► Addressing their questions re. hypnosis questions, assessing and responding to beliefs and fears. ESTABLISHING THE HYPNOTIC RELATIONSHIP PHASE 2. EDUCATION TEACHING THE CONCEPT OF HYPNOSIS ► All hypnosis is self-hypnosis ► Hypnosis involves relaxing the Conscious Mind (about 3-10% of the mind’s activity from child to adult), in order to access the Unconscious Mind (estimated at 97-90% of the mind’s activity). PHASE 2. EDUCATION TEACHING THE CONCEPT OF HYPNOSIS ► Three Components of Hypnosis: 1. Dissociation (Involuntariness, Levels of Consciousness or Unconscious Response) 2. Absorption (or Imaginative Involvement 3. Suggestibility (or Suspension of Critical Judgment) Phase 2. Education (Continued) EDUCATION FOR INFORMED CONSENT ► Hypnosis and the Courts of Law Many courts have had the mistaken idea that simply because hypnosis was used, memory must, therefore, have been contaminated. Therefore, patients/clients must be informed that there is a possibility that anything remembered once hypnosis begins will not be admissable in a court of law. The only way to protect potential rights to testify is to forego the use of hypnosis. PHASE 3. HISTORY TAKING FOR CLINICAL HYPNOSIS Standard psychological or medical evaluations should be established prior to using therapeutic hypnosis. (i.e. any traumas including accidents, deaths, diseases, disasters, phobias, physical and sexual abuse should be noted). In addition, because many people seek hypnosis for belief change work, a more detailed Zero to Five history may be indicated. Many beliefs are formed and stored in the Unconscious Mind by age 5. PHASE 3. HISTORY TAKING FOR CLINICAL HYPNOSIS (Cont.) Routinely, interview for the presenting problem looking for the Cause-Effect clues. (Ex. If a person comes for being a “Chocoholic” – ask who gave them chocolate as a child and seek pertinent details, i.e.: “ my grandmother did.” ) Suggested Response: Clinician: “Is your grandmother still alive?” Client/Patient: “No, she died when I was five.” Clinician: “We often develop habits out of unresolved grief – this is something hypnosis can help you change.” And, continue, questioning re. any other early or later associations with chocolate. PREPARING THE CLIENT FOR HYPNOSIS Define and explain hypnosis Dispel misconceptions, myths, and . unrealistic goals Explore client’s motivation and attitude of cooperation. Explore previous hypnosis. Explain re-alerting PHASE 4. ASSESSMENT OF HYPNOTIZABILITY This phase is addressed informally throughout the presentation of hypnosis – noting the patient/client questions, fears expressed, beliefs about their own ability, cooperativeness in the interview, and body language. Formal assessments are rarely done in clinical sessions now and have been relegated to use by researchers. Clinicians having found the assessments to have negative effects on the patient – clinician relationship setting up “a test” atmosphere of “pass-fail.” Phase 5. Teaching Self-Hypnosis All hypnosis is self-hypnosis (Milton Erickson) There are many ways to induce hypnosis – both indirectly and direct. The clinician is encouraged to present the method that they plan on using for the patient/client and inform them of the process and discuss the suggestions to be utilized for trance – usually, the more participatory – the better. This is the best way to truly establish a team approach to the clinician as guide and the patient/client as the one who is self-hypnotizing Informed Consent Concept of Informed Consent I Information Definitions of Hypnosis • Multidimensional / multi-causal phenomenon Altered state of consciousness Narrowed focus of attention Cognitive variables (e.g. expectations) Imaginative variables (e.g. absorption) Context and interpersonal variables (e.g. role conception) Informed Consent Procedures • Establish state of concentrated attention • Encourage use of focused imagination • Suggestions compatible with patient goals • Unconscious exploration Setting • Office • Hospital • Emergency situations Informed Consent (Cont.) Effectiveness of Hypnosis • Influences autonomic, physiological processes • Influences behaviors, attitudes, cognitions, perceptions, emotions • Symptom amelioration Informed Consent (Cont.) II Competency Licensed health care professional Advanced training in areas of expertise Hypnosis training • Course work • Supervised practice Informed Consent (Cont.) III Voluntary Nature of Ethical Hypnosis Trance Collaborative effort - Formation of a new treatment paradigm– clinician/client team. No influence against patient’s will No loss of consciousness Ability to stop trance experience at any time Self-control skill All hypnosis is self-hypnosis Informed Consent (Cont.) IV Distinction - Conscious Mind - Unconscious Mind V Experience of Hypnosis - Individual Talent - Practice Informed Consent (Cont.) VI Memories Clarify expectations and beliefs about memory in / out of hypnosis Clarify patient’s goals re memories in/out of hypnosis Document verbalization of patient’s understanding Document informed consent Repeat over course of treatment Informed Consent (Cont.) “Recovered memories” through Hypnoprojectives - Obtain Informed consent - Discuss court admissibility - No universal agreement about effects of Hypnosis on memory Memories "recovered" in hypnosis or otherwise - Cannot be presumed to be true or false unless corroborated by another source - Vividness of recall does not equal veracity of memory - Can be utilized as patient’s perceptions / symbols for psychotherapeutic exploration The effects on memory are no more likely to occur from the use of hypnosis than from many non-hypnotic interviewing and interrogative procedures (Hammond, D.C.,2008) Informed Consent Risks VII Use of Hypnosis by qualified professionals is safe and can be beneficial Use of Hypnosis by unqualified persons can lead to complications Benefits Symptom relief Cognitive self-control, mastery Alternatives Treatment without hypnosis Informed Consent Suggested Informed Consent Form Criteria in: Hammond, D., & Elkins, G. (2005). Standards of Training in Clinical Hypnosis. Des Plaines, IL: American Society of Clinical Hypnosis. References Hammond, D.C. and Elkins, G. (2005). Standards of Training in Clinical Hypnosis. Illinois: American Society of Clinical Hypnosis Press. Hammond, D.C., Garver, R.B., Mutter,C.B. et al. (2008). Clinical Hypnosis and Memory: Guidelines For Clinicians and For Forensic Hypnosis (Third Printing). American Society of Clinical Hypnosis: Education & Research Foundation, pp.48-49. Turner, M. (1995-2010). Private Clinical Hypnosis Practice, Case Presentations. (Unpublished).