Transcript Document 7108998

Highlander Counselling
& Mediation (c) 2007
Introduction to
Clinical Hypnosis
Leonard McEwen, MSW, RSW
&
Alex Chisholm, BSC, PT
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& Mediation (c) 2007
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Definitions, History
& Theories
Media Clip
Highlander Counselling
& Mediation (c) 2007
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Hypnosis Defined
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& Mediation (c) 2007
“Hypnosis is a natural state of aroused, attentive
focal concentration with relative suspension of
peripheral awareness. It involves an intensity of
focus that allows the hypnotized person to make
maximal use of innate abilities to control
perception, memory, and somatic function.”
Spiegel & Maldonado, 1999
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– As a tool for health may have originated with Hindus of India
– Sleep temples used suggestion to cure
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Paracelsus (1493-1541)
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– Swiss
– 1st to use magnetic healing
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Valentine Greatrakes (1628-1666)
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– "the Great Irish Stroker"
– Healed people by laying his hands on them and passing
magnets over their bodies
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Gassner (1727-1779)
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– Catholic priest
– Believed that disease was caused by evil spirits and could be
exorcised by incantations and prayer
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Maximilian Hell (1720-1792)
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– Used magnets to heal by applying steel plates to the naked body
– Franz Anton Mesmer was a student
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Dr. Franz Mesmer (1734-1815)
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– Physician from Austria
– Had an effect he called "animal magnetism" or "mesmerism"
– In Paris the medical community challenged him
• The King put together a Board of Inquiry that included chemist
Lavoisier, Benjamin Franklin, and a medical doctor who was an
expert in pain control named Joseph Ignace Guillotin
• Mesmer refused to cooperate with the investigation
• The commission later declared that Mesmerism worked by the
action of the imagination
– Mesmerism remained popular
– Mesmer himself retired to Switzerland in obscurity, where he
died in 1815
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Abbé Faria
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Indo-Portuguese priest
Revived public attention
Early 19th century
Introduced oriental hypnosis to Paris.
Gave exhibitions in 1814 and 1815
Faria claimed that it “generated from within the mind” by the
power of expectancy and cooperation of the patient
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Lucid Sleep
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Concentration rather than animal magnetism
Involuntariness
Father of suggestion theory
Importance of the subject not the hypnotist
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Marquis de Puységur
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– Student of Mesmer
– First described and coined the term somnambulism
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Récamier
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Récamier was the first recorded use of hypnoanesthesia and operated
on patients under mesmeric coma (1821).
Carl Reichenbach 1840s and 1850s began experiments to find any
scientific validity to "mesmeric" energy, which he termed Odic force.
Although his conclusions were quickly rejected in the scientific
community, they did undermine Mesmer's claims of mind control.
Mesmerism in its later guise of hypnotism contained a clear implication
that many saints might be hysterics, leading The Roman Catholic
Church to ban hypnotism until the middle of the 20th century.
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James Braid (1705-1860)
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Coined term hypnosis in 1842
Titled the "Father of Modern Hypnotism"
Rejected Mesmer's idea of magnetism inducing hypnosis
Ascribed the creation of the 'mesmeric trance' to a physiological
process—the prolonged attention on a bright moving object or
similar object of fixation. He postulated that "protracted ocular
fixation" fatigued certain parts of the brain and caused the
trance, "nervous sleep"
– Attempted unsuccessfully to use hypnotism to treat various
psychological and physical conditions
– Others had better results, especially in the use of hypnosis in
pain control
– Braid is credited for writing the first book on hypnosis in 1843
titled Neurypnology
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Dr. John Elliotson (1791-1868)
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– English surgeon
– Reported numerous painless surgical operations using
mesmerism in 1834
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Dr. James Esdaile (1805-1859)
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– Reported on 345 major operations performed using mesmeric
sleep as the sole anesthetic
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Jean-Martin Charcot (1825-1893)
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– Neurologist
– Endorsed hypnotism for the treatment of hysteria.
– Led to a number of systematic experimental examinations of
hypnosis
– Process of post-hypnotic suggestion was first described in this
period. Extraordinary improvements in sensory acuity and
memory were reported under hypnosis
– From the 1880s the examination of hypnosis passed from
surgical doctors to mental health professionals. Charcot had led
the way and his study was continued by his pupil
 Hypnosis as apsychopathological, hysterical process
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Pierre Janet
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– Described the theory of dissociation, the splitting of mental
aspects under hypnosis (or hysteria) so skills and memory could
be made inaccessible or recovered
– Provoked interest in the subconscious and laid the framework for
reintegration therapy for dissociated personalities.
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Jean Charcol
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July 28, 1847
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Decree from the Sacred Congregation of the Holy office
(Roman Curia) declared that "Having removed all
misconception, foretelling of the future, explicit or implicit
invocation of the devil, the use of animal magnetism
(Hypnosis) is indeed merely an act of making use of
physical media that are otherwise licit and hence it is not
morally forbidden provided it does not tend toward an illicit
end or toward anything depraved."
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Pope Pius XII (1956)
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Approval of hypnosis. He stated that the use of hypnosis by health care
professionals for diagnosis and treatment is permitted. In an address
from the Vatican on hypnosis in childbirth.
The Pope gave these guidelines:
– Hypnotism is a serious matter, and not something to be dabbled
in
– In its scientific use, the precautions dictated by both science and
morality are to be followed
– Under the aspect of anaesthesia, it is governed by the same
principles as other forms of anaesthesia
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American Civil War
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– The first extensive medical application of hypnosis
– Introduction of the hypodermic needle and the general chemical
anesthetics of ether in 1846 and chloroform in 1847 to America,
it was much easier for the war's medical community to use
chemical anesthesia than hypnosis
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Ambroise-Auguste Liébault (1864-1904)
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– Founder of the Nancy School
– Wrote of the necessity for cooperation between the hypnotizer
and the participant, for rapport
– Emphasized, with Bernheim, the importance of suggestibility
– Hypersuggestability Theory
– Nancy School with emphasis on hypnosis as a psychological
and not a psychopathological state
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1889
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& Mediation (c) 2007
First International Congress for Experimental and Therapeutic
Hypnotism was in Paris.
Attendees included:
– Jean-Martin Charcot
– Hippolyte Bernheim
– Sigmund Freud
– Ambroise-Auguste Liébeault
British Medical Association Approval, 1892
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Emile Coué (1857-1926)
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– French pharmacist
– Laws of Suggestion
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Sigmund Freud
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Milton Erickson
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Modern Theorists
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Hilgard (1977)
– Dissociatiion/divided consciousness
Ernest Rossi (1980’s, current)
– Stillness and tranquility - Biophysical theories
David Spiegel (1994)
– Aroused, attentive focal concentration
S. Kosslyn (2000)
– Psychological state of focused attention
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Endorsements
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Clinical hypnosis endorsed by the:
– British Medical Association (1955)
– American Medical Association (1958)
– American Psychiatric Association (1961)
– American Psychological Association (1969)
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Theories of Hypnosis
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Neo-Dissociative
Social Pychological
Psychodynamic
Social Learning
Ericksonian Atheoretical Approach
Multidimensional Formulations
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Hypnotic Response
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& Mediation (c) 2007
Multidimensional & Multicausal
– Hereditary
– Physiology
• Lymbic structures or the amygdala and hippocampus
• Ultradian rhythms
• Theta production and right hemispheric dominance
– Dissocative Processes
– Absorption in imagery (imagining “as if”) reduction in reality
orientation
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& Mediation (c) 2007
– Cognitive, motivational and psychosocial variables (expectations,
attidudes, motivations, compliance)
– Interpersonal environmental variables (quality of relationship,
percieved competance, trust, conducive environment)
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Myths
& Misconceptions
Major Myths & Misconceptions
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& Mediation (c) 2007
– Loss of control
– Surrender of will
– Loss of consciousness
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& Mediation (c) 2007
M:
The person being hypnotized will be under the control of the
hypnotist, and can be made to do or say anything the
hypnotist wants.
F:
This is not true.
No matter how deeply hypnotized you become, you will
remain in control throughout the session. You cannot be
made to do anything you do not want to do, or anything that
you are uncomfortable doing.
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M:
Hypnosis is something that is done to people, rather than
something that they can do for themselves.
F:
This is not true.
Hypnosis is a skill you can learn. It is a tool you can use to
help yourself feel better.
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& Mediation (c) 2007
M:
People become trapped in hypnosis and cannot “come out”
of it when they want to.
F:
This is not true.
People can end hypnosis whenever they want.
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& Mediation (c) 2007
M:
People have to be very “hypnotizable” or “suggestible” or
“gullible” for hypnosis to work.
F:
This is not true.
Research has indicated that the vast majority of people can
benefit from hypnosis. Furthermore, being hypnotizable or
choosing to be responsive to suggestions means only that
you have the ability to use hypnosis effectively. It is not at all
related to being gullible or weak-willed.
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& Mediation (c) 2007
M:
During hypnosis, people are unconscious.
F:
This is not true.
During hypnosis, people are not asleep or unconscious.
Although they may feel very relaxed, they are active
participants in the hypnosis session.
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& Mediation (c) 2007
Hypnosis
vs. Relaxation
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& Mediation (c) 2007
Hypnosis
Relaxation is not necessary for hypnotic induction.
Relaxation
Relaxation is being in a relaxed state.
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& Mediation (c) 2007
Hypnosis
Hypnosis can produce analgesia and anaesthesia.
Relaxation
Relaxation does not produce analgesia and anaesthesia.
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Hypnosis
Hypnosis can significantly reduce or abort acute pain.
Relaxation
Relaxation has no significant effect on acute pain.
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Hypnosis
Major surgery tolerated under hypnosis.
Relaxation
Major surgery cannot be tolerated under relaxation.
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& Mediation (c) 2007
Hypnosis
Hypnosis prevents inflammation and swelling in acute
burn cases.
Relaxation
Relaxation does not suppress inflammation and swelling
in acute burn cases.
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& Mediation (c) 2007
Hypnosis
Hypnosis produces dissociation, hallucinations and
delusions.
Relaxation
Dissociation, hallucinations and delusions occur as
epiphenomenon.
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& Mediation (c) 2007
Hypnosis
Hypnosis produces de-realisation and depersonalization.
Relaxation
Derealisation and depersonalization can occur.
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& Mediation (c) 2007
Hypnosis
Hypnosis induces dreams.
Relaxation
Dreams can occur.
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& Mediation (c) 2007
Hypnosis
Hypnosis produces “trance logic”.
Relaxation
There is no “trance logic”.
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Hypnosis
Hypnosis can easily produce amnesia.
Relaxation
Amnesia can occur by chance.
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& Mediation (c) 2007
Hypnosis
Somato-sensory changes easily produced under hypnosis.
Relaxation
Somato-sensory changes can occur as a function of
parasympathetic dominance.
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Hypnosis & Memory
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Its imperfect nature
Trauma memory
Accurate recall
Forensics
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Hypnosis & Creation of Pseudomemory
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– Highly Hypnotizable subjects more prone
– Prehypnotic and hypnotic suggestions must create a neutral
atmosphere as to whether of not further or accurate information
will be revealed
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Assessment,
Presenting Hypnosis
Highlander Counselling
& Mediation (c) 2007
– Standard Psych/Medical evaluations and diagnostics should be
completed prior to using hypnosis
– All hypnosis is really self hypnosis
– Everyday trance
– Everyday absorption experiences
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Informed Consent
Highlander Counselling
& Mediation (c) 2007
– Name hypnosis – don’t use synonym
– Discuss the imperfection of memory and the need to corroborate
hypnotically obtained memory
– Caution about the use of hypnosis and the ability to testify in
court
Handout
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& Mediation (c) 2007
Hypnotic
Phenomena
Media Clip
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& Mediation (c) 2007
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Highlander Counselling
& Mediation (c) 2007
– Research on phenomena associated with hypnosis
– Suggestions for eliciting phenomena
– Applications of hypnotic phenomena
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Ideomotor Phenomena
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Hands moving together
Eye closure
Ideomotor signals
Arm catalepsy, levitation
Autonomic movements
Finger lock
Eye catalepsy
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Ideosensory Activities
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Dissociation
Analgesia
Anasthesia
Hypnotic dreams
Post hypnotic suggestions
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Hyperamnesia & Age Regression
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– Partial regression
– Revivification
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Amnesia & Time Distortion
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– Hidden Observer (ego-state phenomena)
– Negative and positive hallucinations
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Olfactory
Gustatory
Kinesthetic
Auditory
Visual
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Frequency
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& Mediation (c) 2007
– Difficulty of facilitating phenomena
– Classic suggestion effect of experiencing phenomena
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Hypnotic Phenomena Demonstrated
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Hands moving together
Eye closure
Ideomotor signals
Arm catalepsy, levitation
Autonomic movements
Finger lock
Eye catalepsy
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Dissociation
Analgesia
Anesthesia
Hypnotic dreams
Post hypnotic suggestions
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& Mediation (c) 2007
Induction, Re-Alerting
& Suggestions
Steps In Facilitating Induction
Highlander Counselling
& Mediation (c) 2007
– Importance of removing suggestions and realerting clients
– 6 principles of induction and suggestion
– 4 types of suggestions
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Handouts
Facilitating Induction
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& Mediation (c) 2007
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Preparing and educating the client
Fixation of attention and deepening of involvement
Facilitating involuntary or unconscious involvement
Realerting
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& Mediation (c) 2007
Hypnotizability
Title Page
Stages of Hypnosis
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& Mediation (c) 2007
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Advertising
Pre-Session
Waiting Room
Client Interview
Office Presentation
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Induction
Deepening
Session
Alerting
Debriefing
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Intentional Practice
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& Mediation (c) 2007
– Set the stage for hypnosis
– Feed the client’s expectation
– Call for an appointment
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Pre Session
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& Mediation (c) 2007
– Advertisement - CSCH Membership
– Use of Hypnosis as an adjunct
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Waiting Room
Highlander Counselling
& Mediation (c) 2007
– Brochures
– Receptionist distributes client information form which includes
hypnosis related questions
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Client Interviews
Highlander Counselling
& Mediation (c) 2007
What was said to client when appointment was booked?
Are your colleagues aware that you use hypnosis and that you accept
referrals on that basis?
What forms were filled out in the waiting room?
What was learned in the first session?
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Office & Presentation
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Comfort
Subdued lighting
Music
Bathroom
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Induction
Highlander Counselling
& Mediation (c) 2007
Your Chair
– Comfort
– Head support
Your Technique
– Voice
– Pace
Your Office Finishing
– Color
– Comfort
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Deepening
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& Mediation (c) 2007
– Voice and timing
– Image
– Sound
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Session
Highlander Counselling
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– Directive
– Metaphor use
– Post hypnotic suggestion
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Example
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Removing suggestion effects and realerting
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Example
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Rapport and cooperative relationship
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Example
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Creating positive expectancy
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Emile Coué and the Laws of Suggestion
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Coué’s Law
– If imagination and will are in conflict, imagination always wins.
– In other words you can not will yourself to do anything that you
can not imagine yourself doing.
The Law of Concentrated Attention
– Whenever attention is concentrated on an idea over and over
again, it spontaneously tends to realize itself.
The Law of Reversed Effect
– The harder one tries to do something, the less chance one has
of success.
The Law of Dominant Effect
– A strong emotion/suggestion tends to replace a weaker one.
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Example
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The principle of using positive suggestions
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Example
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Principle of trance ratification
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Example
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Value of careful observation
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Example
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Erickson’s Principle of Individualization and utilization of client’s
interests, needs, talents and motivations
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& Mediation (c) 2007
– Direct vs indirect suggestions
• Who wins... Neither
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Truisms and contingent suggestions
Use of questions, implication covering all possible responses
Interspersing suggestions, use of analogies or metaphores
Double Binds
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Hypnotic Induction
Highlander Counselling
& Mediation (c) 2007
Four basic induction techniques
– Eye fixation
– Arm drop
– Hands moving together
– Eye roll
– Coin technique
– Progressive relaxation
– Imagery
– Conversational
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Hypnotic Susceptibility
Highlander Counselling
& Mediation (c) 2007
Long Term Stability of Hypnotic Response
– Genetic?
– Trait involvement (dissociative)?
– Situational and contextual variables
• Burn victims
– No one theory accounts for responsiveness
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Responsiveness
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Is responsivity modifiable?
Do efforts produce only compliance but not increase responsivity?
Age and responsiveness
Two populations with above average responsiveness
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Personality Factors
Highlander Counselling
& Mediation (c) 2007
No specific positive correlation exists between hypnotic responsiveness
and scores on tests such as:
– MMPI
– Thurstone Personality Schedule
– Rorschach
– Thematic Apperception Test
– California Psychological Inventory
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Imaginative Ability, Fantasy Proneness
& Hypnotizability
Highlander Counselling
& Mediation (c) 2007
Hypnotizable person capable of deep imaginative involvement and
almost total immersion in the activity of:
– Reading
– Listening to music
– Experiencing nature
– Engaging in absorbing adventures of body or mind
See Hilgard’s, Personality and Hypnosis (1970)
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Highlander Counselling
& Mediation (c) 2007
As applied to developmental experiences such as:
– Early deep involvement with a noncompetitive experience that
challenges the imagination (reading)
– Willingness to submit to impartial authority (history of
punishment of parent)
– Strong history of identification with opposite-sexed parent
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Absorption & Hypnotizability
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– The capacity for absorbed and self-altering attention
– Highly correlated with attention
– See Tellegen and Atkinson, 1974
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Expectancy & Hypnotizability
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& Mediation (c) 2007
– Erickson was a master at combining psych and physiological
phenomena into expectancy
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Gender & Hypnotizability
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– No difference
– Spiegel and Spiegel 2004
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Age & Hypnotizability
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– Peaks early and slowing declines
– Images not relaxation with children
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Mental Status & Hypnotizability
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– Depends upon researcher/writer
– Note Yapko
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Enhancing Hypnotizability
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– If you read Yapko – Yes
– If you read Spiegel and Spiegel – set the context to allow for
ease of attainment
Spiegel and Spiegel or Yapko
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Hypnotizable Clinical Populations
Highlander Counselling
& Mediation (c) 2007
High (Affective/Mood)
– Axis I
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Dissociative/conversion
Dysthymia
MDD
Brief Psychotic
– Axis II
• Histrionic
• dependant
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Medium (Mixed)
– Axis I
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Impulse Control
Dysthymia
MDD
Bipolar
– Axis II
• Borderline
• Antisocial
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Low (Cognitive)
– Axis I
• OCD
• Schizophrenia
– Axis II
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Paranoid
Schizoid
Schizotypal
OCD
Narcissistic
Avoidant
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Suggestibility In Hypnosis
Highlander Counselling
& Mediation (c) 2007
– Openness to accept new ideas
– Willingness to accept new information or perspectives
– A focused capacity to translate ideas into suggested responses
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Therapist Power
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Coercive (derived from the ability to punish)
Reward (derived from the ability to give rewards – psychological)
Legitimate (derived from position)
Expert (derived from knowledge)
Referent (derived from personal characteristics)
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Need for Acceptance
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& Mediation (c) 2007
– Client feels deficient or incomplete in some way
– Given this, our clients are concerned about whether we will
accept them when they disclose their deficiencies
– Reward and punishment and become a considerable forces in
the process
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Client Expectations
Highlander Counselling
& Mediation (c) 2007
– Self-fulfilling prophecy
– The ideas that a person has about his future experiences will
guide his or her current experiences in that direction
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Client Need for Internal Harmony
Highlander Counselling
& Mediation (c) 2007
– Expectations and the need for cognitive consistency
– Client who has been to every therapist in town and has not been
helped. Expectation and cognitive consistency have client
believing that they are a hopeless case and that they will go to
great lengths to prove it
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Effects Upon Suggestibility
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Let clients know that you use hypnosis as an adjunct
Tell them that hypnosis often forms a part of your practice
Have hypnosis brochures in your waiting room
Discuss it in the first session
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Examples
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How many have had a positive hypnosis experience?
How many expected to experience hypnosis here?
How many considered their willingness to volunteer?
How many are willing to volunteer now?
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Need for Critical Thought
Highlander Counselling
& Mediation (c) 2007
American Society for Clinical Hypnosis
More radical approaches – Yapko
– Some of the following is from Michael Yapko, PhD
– In the next section, some of the information is offered by Yapko
115
Susceptibility - Biology or Learning
Highlander Counselling
& Mediation (c) 2007
– Inconclusive – no studies indicating that susceptibility is learned
or inherited
– Poor subjects tend to remain poor subjects and good subjects
tend to remain good subjects over time
– Age and Hypnotizability
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Children can be and often are highly susceptible
Cannot apply traditional definitions of hypnosis
They often fidget and appear restless
Inactivity (catalepsy) as evidence of hypnosis not likely
Of minor value in determining susceptibility
Of consideration in choosing induction and utilization (ages and
stages)
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Intelligence
Highlander Counselling
& Mediation (c) 2007
– No known correlation
– Intelligence = hypnotizability if this exists it might be due to ability
to concentrate
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Mental Status
Highlander Counselling
& Mediation (c) 2007
– Psychotics and hypnosis assumed in past to be poor but indirect
work can prove results if not rushed
– Must allow for client’s state and building of rapport
– Bipolar in manic phase unlikely
– Drug induced psychosis difficult to overcome
– Clients with senility can be worked with
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Self-Esteem
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What you view as possible for your self
A major component
Seems to be learned
The conclusions which you draw from your experiences
Enhancing self-esteem is any usual goal of hypnosis
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Fantasy Proneness, Imagination & Hypnosis
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Concrete or abstract
Concrete requires more detail
Factor in responsiveness
Factor in approach to use with the client
120
Clinician’s Responsibility
Highlander Counselling
& Mediation (c) 2007
Discover under what circumstances, internal and external, a person is
most responsive to new information and suggested perspectives
Building
Therapeutic Alliance
121
Relationship Factors & Hypnotizability
Highlander Counselling
& Mediation (c) 2007
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Understanding and trust
Cooperative relationship
Collaborative relationship
Hypnosis can be viewed as a naturally arising
It responds within a special kind of relationship, one of mutual
responsibility and accountability
122
High Hypnotic Ability
Highlander Counselling
& Mediation (c) 2007
– Children (9-12)
– Bulimics
– PTSD
– Dissociative disorders
12
3
Light Trance
Highlander Counselling
& Mediation (c) 2007
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Slow deeper breathing
Progressive feelings of lethargy
Observable relaxation
Inhibition of voluntary movements
Eyelid catalepsy
Limb catalepsy
124
Medium Trance
Highlander Counselling
& Mediation (c) 2007
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Glove anesthesia
Partial posthypnotic anesthesia
Partial amnesia
Partial age regression
Some degree of time distortion
Good mental imagery and ability to have dreamlike experience
Aware of external noises but they do not seem to matter
125
Deep Trance (Somnambulism)
Highlander Counselling
& Mediation (c) 2007
– Full age regression
(revivification)
– Positive and negative
hallucinations
– Extensive anesthesia
– Post-hypnotic anesthesia
– Spontaneous amnesia
– Responds to suggestions
for amnesia
– Ability to open eyes without
affecting the trance
– Decrease in spontaneous
mental activity
– Very responsive to
posthypnotic suggestion
– Perceptual distortions and
body dissociation
– Lip Pallor for about 1 cm
beyond the
mucocutaneous margin
126
Plenary Trance (Stuporous)
Highlander Counselling
& Mediation (c) 2007
– Time ceases to be a meaningful concept
– No awareness of physical body
– Loss of awareness of ordinary identity and feeling the potential
to be anything or anyone
– Feeling of oneness with the universe
– Vary significant decrease in pulse and respiration rate
– Spontaneous mental activity ceases
– No awareness of the external world except the very distant voice
of the facilitator (Corydon Hammond, 1988)
127
Highlander Counselling
& Mediation (c) 2007
Deepening
Deepening
Highlander Counselling
& Mediation (c) 2007
129
Points to Remember
Highlander Counselling
& Mediation (c) 2007
What you learned in the client interview may be useful in deepening
– What is the client’s current relaxation practice?
– Have they had previous positive experience with hypnosis?
– What areas are there that are contraindicated because of
previous experience?
130
Points to Remember
Highlander Counselling
& Mediation (c) 2007
What to avoid if it has been associated with trauma
– “white light” and rape
– “waves of relaxation” drowning
– “down, down” and falling
– Others…
131
Highlander Counselling
& Mediation (c) 2007
Many of the deepening techniques can also be used for induction.
132
Highlander Counselling
& Mediation (c) 2007
Methods
of Deepening
Counting
Highlander Counselling
& Mediation (c) 2007
5
4
3
1
2
Counting downwards (implying "going down" deeper into hypnosis)
while offering suggestions of relaxation and come forward between
numbers
Miller, 1979
134
“As If” Method
Highlander Counselling
& Mediation (c) 2007
– Generally a good method for more difficult clients
– No direct suggestion to client to respond in a particular way
– Suggestion to act "as if" he or she were responding in the way
suggested
– Suggesting that the client act "as if" he or she is comfortable,
relaxed, thinking about a happy moments, paves the way for the
client to really experience the suggestions without any actual
personal demands being made
Grinder and Bandler, 1981
135
The Stairs/Elevator Going Down
Highlander Counselling
& Mediation (c) 2007
– The client is told to imagine (that is, see, hear, feel) himself or
herself at the top of a flight of "special stairs" or on a "special
elevator"
– As he or she experiences herself going down the stairs at one
relaxing step at a time he or she can go down deeper into
hypnosis
– Or, as each floor is passed in the descending elevator, he or she
can experience himself or herself going deeper into hypnosis
(Smith and Wester, 1984)
136
Compounding/Chaining
Highlander Counselling
& Mediation (c) 2007
– Tying of one suggestion to another according to the formula "as
you X, you can Y" (that is, "as you read this, you can begin to
understand compounding")
– Verbal compounding serves as a deepening or by continually
building new responses on the framework of passed responses
thus intensifying the hypnotic experience
– "Manual compounding" is the tying of verbal suggestions to
physical experience
– As a deepening it can take the form of offering suggestions of
going deeper into hypnosis while experiencing physical
sensations that reinforce the suggestion (that is, "as your arm
drops slowly to your side, you drop more deeply into hypnosis")
137
The Mind’s Eye Closure
Highlander Counselling
& Mediation (c) 2007
– Useful for turning off the client’s internal dialogue
– Involves offering suggestions about the presence of the "mind’s
eye" as that part of the mind of that remains active in thinking
and imaging as the induction progresses. With suggestions for
the “mind’s eye lids” similar to the “eye fixation” suggestions of
the “eye lids” getting heavy the client can slowly closeout stray
thoughts and images and experience a deeper state of hypnosis
138
Silence
Highlander Counselling
& Mediation (c) 2007
“…you can now have some quiet time to
enjoy the experience of hypnosis."
139
Posthypnotic Suggestions & Re-Induction
Highlander Counselling
& Mediation (c) 2007
– Involves giving the client already in hypnosis a posthypnotic
suggestion that the next time that hypnosis is re-induced, he or
she can go into hypnosis both more deeply and more quickly
– Clinician then guides the person in and out of hypnosis several
times within the same session (Gilligan, 1987; Warner, 1984)
– good for those with short attention span (attention deficit
disorder, physical pain, depression, or other condition that
impairs client’s ability to focus)
140
Client’s Experiences & Office Situation
Highlander Counselling
& Mediation (c) 2007
“… you may find yourself listening to the sounds
outside the office and with each sound you hear
you find yourself being drawn further into your
trance…”
141
Fan
Highlander Counselling
& Mediation (c) 2007
“…as the breeze from the fan touches you, you
will go deeper and deeper into relaxation...”
142
Ring of A Phone
Highlander Counselling
& Mediation (c) 2007
“…with each ring of the phone, you will find
yourself drawn into your own special trance…”
143
Rocking Chair
Highlander Counselling
& Mediation (c) 2007
“…with each rock of the chair you will go deeper
and deeper into your own hypnotic trance…”
144
Other Deepenings
Highlander Counselling
& Mediation (c) 2007
Client’s breathing
– Each time you exhale you will feel yourself drawn into a more
and more relaxed state.
145
Revolving Wheels Fantasy
Highlander Counselling
& Mediation (c) 2007
146
Patient Motivation & Needs
Highlander Counselling
& Mediation (c) 2007
Motorcycle Example
147
Visual Imagery
Highlander Counselling
& Mediation (c) 2007
”you may choose to picture a pendulum swinging. Now you may
notice that with each stroke of the pendulum you are going further
and further into your own hypnotic trance.”
148
Metronome
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149
Highlander Counselling
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Self Hypnosis
Benefits of Self Hypnosis
Highlander Counselling
& Mediation (c) 2007
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Between session change
Continuation of therapeutic focus
Long term maintenance
Situation or Crisis management
151
Yapko and Depression
Highlander Counselling
& Mediation (c) 2007
Give a sleep tape in the first session
152
Applications
Highlander Counselling
& Mediation (c) 2007
Pain
Bruxism
Asthma
Dental procedures
Gastrointestinal problems
Childbirth
Wound healing
Flying and other phobias
Anxiety disorders
Learning
Sleep disorders
Habit control
Sexual dysfunction
Smoking
Stress
others
Bereavement
153
Teaching Self Hypnosis
Highlander Counselling
& Mediation (c) 2007
In your office:
– Post Hypnotic Suggestion for trigger
• Two fingers
• Eyes closing
• Others
– Practice
154
The Client’s 6 Steps to Self Hypnosis
Highlander Counselling
& Mediation (c) 2007
1. Plan the suggestion before going into hypnosis
2. Use your entry cue
3. Count backward from 100-95 slowly, don’t think of suggestion
100,99,98,97,96
4. Give the suggestion as you wrote it at 95
5. Count 94, 93, 92, 91, 90 don’t think about or criticize the suggestion
6. When count reaches 90 give the exit or alert cue
155
Highlander Counselling
& Mediation (c) 2007
Treatment Planning
Applications
Highlander Counselling
& Mediation (c) 2007
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Pain
Asthma
Gastrointestinal Problems
Wound Healing
Anxiety Disorders
Sleep Disorders
Sexual Dysfunction
Stress
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Bruxism
Dental Procedures
Childbirth
Flying and Other Phobias
Learning
Habit Control
Smoking
Others
157
Eyes Open Application
Highlander Counselling
& Mediation (c) 2007
Work Environment
– Before meetings
– Stressful situations
– Performance related situations
Other
– Performance related (relationships, sports)
158
Habit Control
Highlander Counselling
& Mediation (c) 2007
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Nail Biting
Smoking
Weight
Others
159
Phobias
Highlander Counselling
& Mediation (c) 2007
– Flying
– Elevators
– Others
160
Dermatological Conditions
Highlander Counselling
& Mediation (c) 2007
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Anxiety, depression, shame, embarrassment
Reduce rubbing and scratching
Alleviation of warts
Pruritis
Acne, psoriasis
161
Media Clip
Highlander Counselling
& Mediation (c) 2007
162
Asthma
Highlander Counselling
& Mediation (c) 2007
– Desensitization against anticipatory triggers, anxiety, panic
– Suggestion of relaxation, ego-strengthening
– Provoking and alleviating an attack (control training)
163
Gastrointestinal Disorders
Highlander Counselling
& Mediation (c) 2007
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Oesophageal spasm, swallowing problems
Desensitization against triggers
Gastric secretion reduced by imagery
Habitual reflex vomiting
IBS (Whorwell, IBS Treatment Unit)
164
Gut-Directed Hypnotherapy
Highlander Counselling
& Mediation (c) 2007
– Extremely effective
– 12 one hour sessions weekly for a three month period
– Substantial improvement in symptoms and quality of life (81%
maintained improvement over 5 years), Gonsalkorale et al.
(2003).GUT, 52(11), 1623-1629.
165
Erections & Irritable Bowel Syndrome
Highlander Counselling
& Mediation (c) 2007
166
Burns
Highlander Counselling
& Mediation (c) 2007
– Stop inflammation and swelling
– Reduce pain and distress
– Debridement of tissues and changing dressings
167
Media Clip
Highlander Counselling
& Mediation (c) 2007
168
Cancer
Highlander Counselling
& Mediation (c) 2007
– Pain, anxiety, depression, feelings of hopelessness, sideeffects
– NIH study of 10-year follow-up of 86 patients with
metastatic breast carcinoma
– Patients with self-hypnosis and group therapy had 50%
less pain and survived 18 months longer, Kogan et al.
(1997). Cancer, 80, 225-230
169
Chronic Pain
Highlander Counselling
& Mediation (c) 2007
“Nobody wants to hurt, and pain interferes with healing, so
it is no wonder that one of the most rewarding uses of
hypnosis is its ability to influence the perception of pain.”
Barabasz & Watkins, 2005, p.231
170
Headaches & Migraines
Highlander Counselling
& Mediation (c) 2007
– Shown to be efficacious with headache and migraine
– Relatively brief and cost effective
– Virtually free of the side effects, risks of adverse reactions, and
ongoing expense
“Hypnosis should be recognized by the scientific, health
care, and medical insurance communities as being an
efficient evidence based practice.”
Hammond (2007)
171
Surgery
Highlander Counselling
& Mediation (c) 2007
– Esdaile (1957) reported 345 major operations performed in
India with hypnosis
– Hilgard and Hilgard (1975) reported 14 different types of
surgeries, hypnosis used as sole anesthetic
– Multiple case studies (1955-1992: 24 cases reported)
– Surgery Dental hypnosis (hypnodontia)
172
Media Clip
Highlander Counselling
& Mediation (c) 2007
173
Phobia
Highlander Counselling
& Mediation (c) 2007
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Dentistry
Spaces
Birds
Injections
174
Hypnotherapy With Pain
Highlander Counselling
& Mediation (c) 2007
– Meta-analytic review of 18 articles and 27 effect sizes
indicated that hypnotic suggestions relieve pain for 75% of
933 subjects across different types of pain (Montgomery,
DuHamel & Redd, 2000).
– Lynn et al (2000) concluded that hypnosis can be
considered a well-established treatment for pain.
175
Highlander Counselling
& Mediation (c) 2007
– Review by Brannon & Feist (2004) indicated effectiveness with
headache, cancer pain, burn pain, childbirth discomfort, dental
pain, surgery pain, low back pain, experimental pain, and pain
from sickle cell disease.
176
Highlander Counselling
& Mediation (c) 2007
– Elkins et al. (2007) reviewed 13 studies, excluding studies of
headaches, that compared outcomes from hypnosis for the
treatment of chronic pain to either baseline data or a control
condition.
– Hypnosis interventions consistently produced significant
decreases in pain associated with a variety of chronic pain
problems such as:
•
•
•
•
•
•
Cancer
Low back pain
Arthritis pain
Sickle cell disease
Temporomandibular pain
Disability-related pain
177
Highlander Counselling
& Mediation (c) 2007
“Hypnosis is now the pain-control method of choice for
interventional radiological procedures at Harvard Medical
School’s Beth Israel Deaconess Medical Centre in Boston.
Recoveries are faster, patients are more satisfied, and the
hospital saves considerable sums of money while reducing
risk exposure.”
Lang et al., 2000, Lancet, 355, 1486-1490
178
Yapko & Depression
Highlander Counselling
& Mediation (c) 2007
Give a sleep tape in the first session
179
Indications for Hypnosis
Highlander Counselling
& Mediation (c) 2007
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Has requisite hypnotizability
Co-operative with procedure
Problem shown to be effective with hypnosis
Condition diagnosed/adjunct
No florid psychotic symptoms
Absence of mania
Not under the influence of illicit drugs or alcohol
Not actively suicidal
Not with certain personality disorders
180
Contraindications
Highlander Counselling
& Mediation (c) 2007
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Low score on hypnotizability
Uncooperative with procedure
Problem shown not to be effective with hypnosis
Condition not diagnosed
Presence of florid psychosis
During mania
During intoxication with illicit drugs or alcohol
Actively suicidal
Borderline, narcissistic, and antisocial personalities
181
Self Hypnosis
Highlander Counselling
& Mediation (c) 2007
– Define self hypnosis
– Teaching self hypnosis to clients
– Therapeutic applications of self hypnosis in practice
182
Highlander Counselling
& Mediation (c) 2007
Establishing self hypnosis induction cues
– Post hypnotic suggestion
– In session practice
– Recordings
The value of individualized audio tapes
– Medical (pain, asthma, GI, wound, dermatological)
– Psychiatric (Sleep, ego-strengthening, sexual dysfunction)
183
Treatment Planning
Highlander Counselling
& Mediation (c) 2007
– Suggestive and insight oriented hypnotic approaches
– Hypnosis indicated or contraindicated
– Types of strategies or therapeutic goals
184
Highlander Counselling
& Mediation (c) 2007
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Consider symptom complexity and intensity
Level of hypnotic talent and responsivity
Client expectations or preferences
Degree of psychological-mindedness and impulse control
Personality, dominant defence coping style
Diagnosis
Stage in change process
185
Highlander Counselling
& Mediation (c) 2007
– Rapport
– Degree of resistance
– Locus of control
186
Highlander Counselling
& Mediation (c) 2007
Managing Resistance
Strategies
Highlander Counselling
& Mediation (c) 2007
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Enhancement of insight
Abreaction or emotional facilitation
Perceptual change
Reduction or alteration of affect
Facilitation of behavioral change
Facilitation of physiological change
188
Source of Resistance
Highlander Counselling
& Mediation (c) 2007
Sources of Resistance
– Patient
– Therapist
– Environmental
189
Resistance to Hypnosis
Highlander Counselling
& Mediation (c) 2007
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Education about myths and misconceptions
Separating hypnosis from the presenting problem
Creating healthy therapeutic alliance
Aligning patient/therapist goals
Accepting and using patient responses
Shifting to indirect permissive techniques
Exploring the resistance consciously and with insight oriented
hypnotic techniques
190
Highlander Counselling
& Mediation (c) 2007
– Obtain the clients feedback, critique and discussion of what
interfered with responsiveness
– Recall of previous successful induction
– Modeling a successful subject
191
Advantages
Highlander Counselling
& Mediation (c) 2007
Advantages
– Objective method of evaluating responsivity to hypnosis and who
is likely to benefit
– Gain info about hypnotic talents and boost therapist confidence
– Modelling for clinicians in how to elicit phenomena
192
Disadvantages
Highlander Counselling
& Mediation (c) 2007
Disadvantages
– Tend to be directive and may result in objections
– Provide only one sample of responsiveness (not always
predictive)
193
Highlander Counselling
& Mediation (c) 2007
Hypnotic Susceptibly Scale
Hypnotic Susceptibility Tests
Highlander Counselling
& Mediation (c) 2007
Barber Suggestibility Scale (Barber, 1976)
Carlton University Responsiveness to Suggestions Scale (Spanos,
Radtke, Hodgkins, Stram and Bertrand, 1983)
Creative Imagination Scale (Wilson and Barber, 1977)
Davis-Husband Scale (Davis and Husband, 1931)
Field inventory (Self-report) (Field, 1965)
Handouts
195
Highlander Counselling
& Mediation (c) 2007
"The debate continues over just how useful clinical scales are in
treatment. Their value in research is beyond question. However, it
is unclear how relevant and responsive to standardized, therefore
not individualized, a test item is to eventual clinical results
obtained."
196
Susceptibility Assessment Tools
Highlander Counselling
& Mediation (c) 2007
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Barber
Stanford Hypnosis Susceptibility Scale
Hypnotic Induction Profile
HIP Modified
197
Hypnosis Induction Profile
Highlander Counselling
& Mediation (c) 2007
A measurement tool and an induction
198
Highlander Counselling
& Mediation (c) 2007
Ethics
Ethics
Highlander Counselling
& Mediation (c) 2007
– Ethical and Legal Issues and standards of professional conduct
– Certification requirements in Clinical Hypnosis
• The unfolding of CFCH
Handouts
200
Highlander Counselling
& Mediation (c) 2007
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Informed consent
Adherence to guidelines and cautions
Memory work
Only using it to treat what one is qualified to treat with non
hypnotic methods
– Professional registration requirements
– Power imbalance in the counselling room
– CFCH, ASCH, ASCEH
201
Highlander Counselling
& Mediation (c) 2007
Integrating Hypnosis
Into Practice
Small Group Practice
Highlander Counselling
& Mediation (c) 2007
– Each person will have three opportunities to be a subject and a
therapist using hypnosis
– Small group leaders will not demonstrate techniques or answer
questions during this time
– Small group leaders will provide feedback and brief modelling of
alternate verbalizations
203
Highlander Counselling
& Mediation (c) 2007
Certificates Presented