Clinical (c) 2007 Hypnosis Leonard McEwen & Lynn Lambert

8/4/2019 Clinical (c) 2007 Hypnosis Leonard McEwen & Lynn Lambert

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Highlander Counselling

& Mediation (c) 2007

ClinicalClinical

HypnosisHypnosis

Leonard McEwen

&

Lynn Lambert

Highlander Counselling& Mediation (c) 2007

FridayFriday

8:30-9:10 Definition History and Theories ofHypnosis

9:10-9:40 Myths and Misconceptions

9:40-10:00 Coffee

10:00-10:20 Assessment, Presenting Hypnosis

10:20-11:20 Hypnotic Phenomena


11:20-12:00 Induction and Realerting

12:00-1:00 Lunch

1:00-3:00 Induction and Realerting Cont'd

3:00- 3:15 Cof fee

3:15-4:15 Demonstrations of Inductions

4:15-5:15 Eliciting Hypnotic Phenomena


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8:30-9:30 Susceptibility, Stages of Hypnosis

9:30- 9:45 Cof fee

9:45-10:30 Self Hypnosis

10:30-11:30 Treatment Planning

11:30-12:15 Managing Resistance

SaturdaySaturday


1:15-1:45 Hypnotic Susceptibility Scales

1:45-2:15 Ethical Principles, Professional Conduct,Certification

2:15-3:00 Integrating Hypnosis Into Practice

3:00- 3:15 Cof fee

3:30-5:00 Integrating Hypnosis Cont'd



9:00-11:30 Integrating Hypnosis Cont'd

11:30-12:30 Lunch

12:30-2:30 Experiential Sessions

2:30- 2:45 Cof fee

2:45-5:00 Experiential Sessions Cont'd

SundaySunday


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Leonard McEwen

&

Lynn Lambert

Your PresentersYour Presenters

V2


Please remember to sign in for each session

Sign InSign In



Definitions, History &Definitions, History &

TheoriesTheories

Title Page


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V2 Handout our practice brochuresVIP, 11/09/2007


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MEDIA CLIPMEDIA CLIP


Hypnosis is a natural state of aroused, attentivefocal concentration with relative suspension of

peripheral awareness. It involves an intensity offocus that allows the hypnotized person to make

maximal use of innate abilities to controlperception, memory, and somatic function.

Spiegel & Maldonado, 1999

Hypnosis DefinedHypnosis Defined

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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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Swiss

1st to use magnetic healing

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Paracelsus (1493Paracelsus (1493--1541)1541)


"the Great Irish Stroker"

Healed people by laying his hands on them and passingmagnets over their bodies

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ValentineValentine GreatrakesGreatrakes (1628(1628--1666)1666)



Catholic priest

Believed that disease was caused by evil spirits and could beexorcised by incantations and prayer

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GassnerGassner (1727(1727--1779)1779)


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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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Maximilian Hell (1720Maximilian Hell (1720--1792)1792)


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Dr. Franz Mesmer (1734Dr. Franz Mesmer (1734--1815)1815)

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 anexpert in pain control named Joseph Ignace Guillotin

Mesmer refused to cooperate with the investigation

The commission later declared that Mesmerism worked by theaction of the imagination

Mesmerism remained popular

Mesmer himself retired to Switzerland in obscurity, where he

died in 1815



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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 thepower of expectancy and cooperation of the patient

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AbbAbb FariaFaria


Concentration rather than animal magnetism

Involuntariness

Father of suggestion theory

Importance of the subject not the hypnotist

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Lucid SleepLucid Sleep



Student of Mesmer

First described and coined the term somnambulism

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Marquis de PuysMarquis de Puysgurgur


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Rcamier was the first recorded use of hypnoanesthesia and operatedon patients under mesmeric coma (1821).

Carl Reichenbach 1840s and 1850s began experiments to find anyscientific 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 implicationthat many saints might be hysterics, leading The Roman CatholicChurch to ban hypnotism until the middle of the 20th century.

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RRcamiercamier


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 physiologicalprocessthe prolonged attention on a bright moving object orsimilar object of fixation. He postulated that "protracted ocularfixation" fatigued certain parts of the brain and caused thetrance, "nervous sleep"

Attempted unsuccessfully to use hypnotism to treat various

psychological and physical conditions

Others had better results, especially in the use of hypnosis inpain control

Braid is credited for writing the first book on hypnosis in 1843titled Neurypnology

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James Braid (1705James Braid (1705--1860)1860)



English surgeon

Reported numerous painless surgical operations usingmesmerism in 1834

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Dr. JohnDr. John ElliotsonElliotson (1791(1791--1868)1868)


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Reported on 345 major operations performed using mesmericsleep as the sole anesthetic

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Dr. JamesDr. James EsdaileEsdaile (1805(1805--1859)1859)


Neurologist

Endorsed hypnotism for the treatment of hysteria.

Led to a number of systematic experimental examinations ofhypnosis

Process of post-hypnotic suggestion was first described in thisperiod. Extraordinary improvements in sensory acuity andmemory were reported under hypnosis

From the 1880s the examination of hypnosis passed fromsurgical doctors to mental health professionals. Charcot had ledthe way and his study was continued by his pupil

Hypnosis as apsychopathological, hysterical process

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JeanJean--Martin Charcot (1825Martin Charcot (1825--1893)1893)



Described the theory of dissociation, the splitting of mental

aspects under hypnosis (or hysteria) so skills and memory couldbe made inaccessible or recovered

Provoked interest in the subconscious and laid the framework forreintegration therapy for dissociated personalities.

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Pierre JanetPierre Janet


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JeanJean CharcolCharcol


Decree from the Sacred Congregation of the Holy office(Roman Curia) declared that "Having removed allmisconception, foretelling of the future, explicit or implicitinvocation of the devil, the use of animal magnetism(Hypnosis) is indeed merely an act of making use ofphysical media that are otherwise licit and hence it is notmorally forbidden provided it does not tend toward an illicitend or toward anything depraved."

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July 28, 1847July 28, 1847



Approval of hypnosis. He stated that the use of hypnosis by health careprofessionals 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 dabbledin

In its scientific use, the precautions dictated by both science andmorality are to be followed

Under the aspect of anaesthesia, it is governed by the sameprinciples as other forms of anaesthesia

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Pope Pius XII (1956)Pope Pius XII (1956)


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The first extensive medical application of hypnosis

Introduction of the hypodermic needle and the general chemicalanesthetics of ether in 1846 and chloroform in 1847 to America,it was much easier for the war's medical community to usechemical anesthesia than hypnosis

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American Civil WarAmerican Civil War


Founder of the Nancy School

Wrote of the necessity for cooperation between the hypnotizerand 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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AmbroiseAmbroise--AugusteAuguste LiLibaultbault (1864(1864--1904)1904)



First International Congress for Experimental and TherapeuticHypnotism was in Paris.

Attendees included:

Jean-Martin Charcot

Hippolyte Bernheim

Sigmund Freud

Ambroise-Auguste Libeault

British Medical Association Approval, 1892

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18891889


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French pharmacist

Laws of Suggestion

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EmileEmile CouCou (1857(1857--1926)1926)


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Sigmund FreudSigmund Freud



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Milton EricksonMilton Erickson


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Modern TheoristsModern Theorists

Hilgard (1977)

Dissociatiion/divided consciousness

Ernest Rossi (1980s, 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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EndorsementsEndorsements

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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Neo-Dissociative

Social Pychological

Psychodynamic

Social Learning

Ericksonian Atheoretical Approach

Multidimensional Formulations

Theories of HypnosisTheories of Hypnosis

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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 realityorientation

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Hypnotic ResponseHypnotic Response


Cognitive, motivational and psychosocial variables (expectations,attidudes, motivations, compliance)

Interpersonal environmental variables (quality of relationship,

percieved competance, trust, conducive environment)

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MythsMyths

& Misconceptions& Misconceptions

Title Page


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Loss of control

Surrender of will

Loss of consciousness

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Major Myths & MisconceptionsMajor Myths & Misconceptions


M: The person being hypnotized will be under thecontrol of the hypnotist, and can be made to do orsay 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 notwant to do, or anything that you are uncomfortabledoing.

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M: Hypnosis is something that is done to people,rather than something that they can do forthemselves.


Hypnosis is a skill you can learn. It is a tool youcan use to help yourself feel better.

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M: People become trapped in hypnosis and cannotcome out of it when they want to.


People can end hypnosis whenever they want.

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M: People have to be very hypnotizable or suggestible or

gullible for hypnosis to work.


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 thatyou have the ability to use hypnosis effectively. It is not at all

related to being gullible or weak-willed.

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M: During hypnosis, people are unconscious.


During hypnosis, people are not asleep orunconscious. Although they may feel very relaxed,they are active participants in the hypnosissession.

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HypnosisHypnosis

vs. Relaxationvs. Relaxation

Title Page


Hypnosis

Relaxation is not necessary for hypnotic induction.

Relaxation

Relaxation is being in a relaxed state.

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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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Hypnosis

Hypnosis prevents inflammation and swelling in acuteburn cases.

Relaxation

Relaxation does not suppress inflammation and swellingin acute burn cases.


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Hypnosis

Hypnosis produces dissociation, hallucinations anddelusions.

Relaxation

Dissociation, hallucinations and delusions occur asepiphenomenon.


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Hypnosis

Hypnosis produces de-realisation and depersonalization.

Relaxation

Derealisation and depersonalization can occur.



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Hypnosis

Hypnosis induces dreams.

Relaxation

Dreams can occur.


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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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Hypnosis

Somato-sensory changes easily produced under hypnosis.

Relaxation

Somato-sensory changes can occur as a function ofparasympathetic dominance.


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Its imperfect nature

Trauma memory

Accurate recall

Forensics

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Hypnosis & MemoryHypnosis & Memory


Highly Hypnotizable subjects more prone

Prehypnotic and hypnotic suggestions must create a neutralatmosphere as to whether of not further or accurate information

will be revealed

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Hypnosis & Creation ofHypnosis & Creation of PseudomemoryPseudomemory



Assessment,Assessment,

Presenting HypnosisPresenting Hypnosis

Title Page


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Standard Psych/Medical evaluations and diagnostics should becompleted prior to using hypnosis

All hypnosis is really self hypnosis

Everyday trance

Everyday absorption experiences

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Name hypnosis dont use synonym

Discuss the imperfection of memory and the need to corroboratehypnotically obtained memory

Caution about the use of hypnosis and the ability to testify in

court

Handout

Informed ConsentInformed Consent

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HypnoticHypnotic

PhenomenaPhenomena

Title Page


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Media ClipMedia Clip


Research on phenomena associated with hypnosis

Suggestions for eliciting phenomena

Applications of hypnotic 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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IdeomotorIdeomotor PhenomenaPhenomena


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Dissociation

Analgesia

Anasthesia

Hypnotic dreams

Post hypnotic suggestions

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Ideosensory ActivitiesIdeosensory Activities


Partial regression

Revivification

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HyperamnesiaHyperamnesia & Age Regression& Age Regression



Hidden Observer (ego-state phenomena)

Negative and positive hallucinations

Olfactory

Gustatory

Kinesthetic

Auditory

Visual

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Amnesia & Time DistortionAmnesia & Time Distortion


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Difficulty of facilitating phenomena

Classic suggestion effect of experiencing phenomena

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FrequencyFrequency


Induction, ReInduction, Re--AlertingAlerting

& Suggestions& Suggestions

Title Page



Importance of removing suggestions and realerting clients

6 principles of induction and suggestion

4 types of suggestions

Handouts75

Steps In Facilitating InductionSteps In Facilitating Induction


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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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Facilitating InductionFacilitating Induction






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Eliciting Hypnotic Phenomena




Eye closure

Ideomotor signals

Arm catalepsy, levitation

Autonomic movements

Finger lock

Eye catalepsy

Hypnotic Phenomena DemonstratedHypnotic Phenomena Demonstrated

Dissociation

Analgesia

Anesthesia

Hypnotic dreams

Post hypnotic suggestions

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HypnotizabilityHypnotizability

Title Page


Stages of HypnosisStages of Hypnosis

Advertising

Pre-Session

Waiting Room

Client Interview

Office Presentation

Induction

Deepening

Session

Alerting

Debriefing

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Intentional PracticeIntentional Practice

Set the stage for hypnosis

Feed the clients expectation

Call for an appointment

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Pre SessionPre Session

Advertisement - CSCH Membership

Use of Hypnosis as an adjunct

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Waiting RoomWaiting Room

Brochures

Receptionist distributes client information form which includeshypnosis related questions

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Client InterviewsClient Interviews

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 & PresentationOffice & Presentation

Comfort

Subdued lighting

Music

Bathroom

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InductionInduction

Your Chair

Comfort

Head support

Your Technique

Voice

Pace

Your Office Finishing

Color

Comfort

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DeepeningDeepening

Voice and timing

Image

Sound

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SessionSession

Directive

Metaphor use

Post hypnotic suggestion

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Removing suggestion effects and realerting

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ExampleExample


Rapport and cooperative r elationship

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ExampleExample



Creating positive expectancy

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ExampleExample


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EmileEmile CouCou and the Laws of Suggestionand the Laws of Suggestion

Cous Law

If imagination and will are in conflict, imagination always wins.

In other words you can not will yourself to do anything that youcan not imagine yourself doing.

The Law of Concentrated Attention

Whenever attention is concentrated on an idea over and overagain, it spontaneously tends to realize itself.

The Law of Reversed Effect

The harder one tries to do something, the less chance one hasof success.

The Law of Dominant Effect

A strong emotion/suggestion tends to replace a weaker one.

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The principle of using positive suggestions

ExampleExample

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Principle of trance ratification

ExampleExample

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Value of careful observation

ExampleExample

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Ericksons Principle of Individualization and utilization of clientsinterests, needs, talents and motivations

ExampleExample

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Direct vs indirect suggestions

Who wins... Neither

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 InductionHypnotic Induction

Four basic induction techniques

Eye fixation

Arm drop


Eye roll

Coin technique

Progressive relaxation

Imagery

Conversational

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Long Term Stability of Hypnotic Response

Genetic?

Trait involvement (dissociative)?

Situational and contextual variables

Burn victims

No one theory accounts for responsiveness

Hypnotic SusceptibilityHypnotic Susceptibility

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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

ResponsivenessResponsiveness

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Personality FactorsPersonality Factors

No specific positive correlation exists between hypnotic responsivenessand scores on tests such as:

MMPI

Thurstone Personality Schedule

Rorschach

Thematic Apperception Test

California Psychological Inventory

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Hypnotizable person capable of deep imaginative involvement andalmost total immersion in the activity of:

Reading

Listening to music

Experiencing nature Engaging in absorbing adventures of body or mind

See Hilgards, Personality and Hypnosis (1970)

Imaginative Ability, Fantasy Proneness &Imaginative Ability, Fantasy Proneness &

HypnotizabilityHypnotizability

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As applied to developmental experiences such as:

Early deep involvement with a noncompetitive experience thatchallenges the imagination (reading)

Willingness to submit to impartial authority (history ofpunishment of parent)

Strong history of identification with opposite-sexed parent

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The capacity for absorbed and self-altering attention

Highly correlated with attention

See Tellegen and Atkinson, 1974

Absorption & HypnotizabilityAbsorption & Hypnotizability

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Erickson was a master at combining psych and physiologicalphenomena into expectancy

Expectancy & HypnotizabilityExpectancy & Hypnotizability

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No difference

Spiegel and Spiegel 2004

Gender & HypnotizabilityGender & Hypnotizability

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Peaks early and slowing declines

Images not relaxation with children

Age & HypnotizabilityAge & Hypnotizability

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Depends upon researcher/writer

Note Yapko

Mental Status & HypnotizabilityMental Status & Hypnotizability

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If you read Yapko Yes

If you read Spiegel and Spiegel set the context to allow forease of attainment

Spiegel and Spiegel or Yapko

Enhancing HypnotizabilityEnhancing Hypnotizability

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Hypnotizable Clinical PopulationsHypnotizable Clinical Populations

High (Affective/Mood)

Axis I

Dissociative/conversion

Dysthymia

MDD

Brief Psychotic

Axis II

Histrionic

dependant

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Medium (Mixed)

Axis I

Impulse Control

Dysthymia

MDD

Bipolar

Axis II Borderline

Antisocial

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Low (Cognitive)

Axis I

OCD

Schizophrenia

Axis II

Paranoid

Schizoid

Schizotypal

OCD

Narcissistic

Avoidant

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Openness to accept new ideas

Willingness to accept new information or perspectives

A focused capacity to translate ideas into suggested responses

Suggestibility In HypnosisSuggestibility In Hypnosis

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Therapist PowerTherapist Power

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 AcceptanceNeed for Acceptance

Client feels deficient or incomplete in some way

Given this, our clients are concerned about whether we willaccept them when they disclose their deficiencies

Reward and punishment and become a considerable forces inthe process

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Client ExpectationsClient Expectations

Self-fulfilling prophecy

The ideas that a person has about his future experiences willguide his or her current experiences in that direction

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Client Need for Internal HarmonyClient Need for Internal Harmony

Expectations and the need for cognitive consistency

Client who has been to every therapist in town and has not beenhelped. Expectation and cognitive consistency have client

believing that they are a hopeless case and that they will go togreat lengths to prove it

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Effects Upon SuggestibilityEffects Upon Suggestibility

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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ExamplesExamples

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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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

Need for Critical ThoughtNeed for Critical Thought

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Inconclusive no studies indicating that susceptibility is learnedor inherited

Poor subjects tend to remain poor subjects and good subjectstend to remain good subjects over time

Age and Hypnotizability 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 andstages)

SusceptibilitySusceptibility -- Biology or LearningBiology or Learning

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IntelligenceIntelligence

No known correlation

Intelligence = hypnotizability if this exists it might be due to abilityto concentrate

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Mental StatusMental Status

Psychotics and hypnosis assumed in past to be poor but indirectwork can prove results if not rushed

Must allow for clients 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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SelfSelf--EsteemEsteem

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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Concrete or abstract

Concrete requires more detail

Factor in responsiveness

Factor in approach to use with the client

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Fantasy Proneness, Imagination & HypnosisFantasy Proneness, Imagination & Hypnosis


Discover under what circumstances, internal and external, a person ismost responsive to new information and suggested perspectives

Building

Therapeutic Alliance

ClinicianClinicians Responsibilitys Responsibility

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Relationship Factors & HypnotizabilityRelationship Factors & Hypnotizability

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

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High Hypnotic AbilityHigh Hypnotic Ability

Children (9-12)

Bulimics

PTSD

Dissociative disorders

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Slow deeper breathing

Progressive feelings of lethargy

Observable relaxation

Inhibition of voluntary movements

Eyelid catalepsy

Limb catalepsy

Light TranceLight Trance

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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

Medium TranceMedium Trance

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Full age regression(revivification)

Positive and negativehallucinations

Extensive anesthesia

Post-hypnotic anesthesia

Spontaneous amnesia

Responds to suggestionsfor amnesia

Ability to open eyes withoutaffecting the trance

Decrease in spontaneousmental activity

Very responsive toposthypnotic suggestion

Perceptual distortions andbody dissociation

Lip Pallor for about 1 cmbeyond themucocutaneous margin

Deep Trance (Somnambulism)Deep Trance (Somnambulism)

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Time ceases to be a meaningful concept

No awareness of physical body

Loss of awareness of ordinary identity and feeling the potentialto 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)

Plenary Trance (Plenary Trance (StuporousStuporous))

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DeepeningDeepening

Title Page


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DeepeningDeepening

139


What you learned in the client interview may be useful in deepening

What is the clients current relaxation practice?

Have they had previous positive experience with hypnosis?

What areas are there that are contraindicated because of

previous experience?

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Points to RememberPoints to Remember



What to avoid if it has been associated with trauma

white light and rape

waves of relaxation drowning

down, down and falling

Others

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Points to RememberPoints to Remember


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Many of the deepening techniques can also be used for induction.

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MethodsMethods

of Deepeningof Deepening

Title Page



Counting downwards (implying "going down" deeper into hypnosis)while offering suggestions of relaxation and come forward between

numbers

Miller, 1979

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CountingCounting

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5 1


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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 waysuggested

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 actualpersonal demands being made

Grinder and Bandler, 1981

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As IfAs If MethodMethod


The client is told to imagine (that is, see, hear, feel) himself orherself at the top of a flight of "special stairs" or on a "specialelevator"

As he or she experiences herself going down the stairs at onerelaxing step at a time he or she can go down deeper intohypnosis

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)

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The Stairs/Elevator Going DownThe Stairs/Elevator Going Down



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 tounderstand compounding")

Verbal compounding serves as a deepening or by continuallybuilding new responses on the framework of passed responsesthus intensifying the hypnotic experience

"Manual compounding" is the tying of verbal suggestions tophysical experience

As a deepening it can take the form of offering suggestions ofgoing deeper into hypnosis while experiencing physicalsensations that reinforce the suggestion (that is, "as your arm

drops slowly to your side, you drop more deeply into hypnosis")

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Compounding/ChainingCompounding/Chaining


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Useful for turning off the clients internal dialogue

Involves offering suggestions about the presence of the "minds

eye" as that part of the mind of that remains active in thinkingand imaging as the induction progresses. With suggestions forthe minds eye lids similar to the eye fixation suggestions ofthe eye lids getting heavy the client can slowly closeout straythoughts and images and experience a deeper state of hypnosis

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The MindThe Minds Eye Closures Eye Closure


you can now have some quiet time toenjoy the experience of hypnosis."

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SilenceSilence



Involves giving the client already in hypnosis a posthypnoticsuggestion 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 thatimpairs clients ability to focus)

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Posthypnotic Suggestions & RePosthypnotic Suggestions & Re--InductionInduction


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ClientClients Experiences & Office Situations Experiences & Office Situation

you may find yourself listening to the soundsoutside the office and with each sound you hear

you find yourself being drawn further into your

trance

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as the breeze from the fan touches you, youwill go deeper and deeper into relaxation...

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FanFan



with each ring of the phone, you will find

yourself drawn into your own special trance

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Ring of A PhoneRing of A Phone


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with each rock of the chair you will go deeper

and deeper into your own hypnotic trance

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Rocking ChairRocking Chair


Clients breathing

Each time you exhale you will feel yourself drawn into a moreand more relaxed state.

Other DeepeningsOther Deepenings

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Revolving Wheels FantasyRevolving Wheels Fantasy


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Patient Motivation & NeedsPatient Motivation & Needs

Motorcycle ExampleMotorcycle Example


Visual ImageryVisual Imagery

you may choose to picture a pendulum swinging. Now you maynotice that with each stroke of the pendulum you are going further

and further into your own hypnotic trance.

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159

MetronomeMetronome


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Self Hypnosis


Benefits of Self HypnosisBenefits of Self Hypnosis

Between session change

Continuation of therapeutic f ocus

Long term maintenance

Situation or Crisis management



YapkoYapko and Depressionand Depression

Give a sleep tape in the first session


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ApplicationsApplications

Pain

Asthma

Gastrointestinal problems

Wound healing

Anxiety disorders

Sleep disorders

Sexual dysfunction

Stress

Bereavement

Bruxism

Dental procedures

Childbirth

Flying and other phobias

Learning

Habit control

Smoking

others


Teaching SelfTeaching Self--hypnosishypnosis

In your office:

Post Hypnotic Suggestion for trigger

Two fingers

Eyes closing

Others

Practice



The clientThe clients 6 steps to selfs 6 steps to self--hypnosishypnosis

Plan the suggestion before going into hypnosis

Use your entry cue

Count backward from 100-95 slowly, dont think of suggestion100,99,98,97,96

Give the suggestion as you wrote it at 95

Count 94, 93, 92, 91, 90 dont think about or criticize the suggestion

When count reaches 90 give the exit or alert cue


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Treatment Planning


ApplicationsApplications

Pain

Asthma

Gastrointestinal Problems

Wound Healing

Anxiety Disorders

Sleep Disorders

Sexual Dysfunction

Stress

Bruxism

Dental Procedures

Childbirth

Flying and Other Phobias

Learning

Habit Control

Smoking

Others

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7



Work Environment Before meetings

Stressful situations

Performance related situations

Other Performance related (relationships, sports)

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Eyes Open ApplicationEyes Open Application


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Nail Biting

Smoking

Weight

Others

Habit ControlHabit Control

169


Flying

Elevators

Others

PhobiasPhobias

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0



Anxiety, depression, shame, embarrassment

Reduce rubbing and scratching

Alleviation of warts

Pruritis

Acne, psoriasis

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Dermatological ConditionsDermatological Conditions


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Desensitization against anticipatory triggers, anxiety, panic

Suggestion of relaxation, ego-strengthening

Provoking and alleviating an attack (control training)

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3

AsthmaAsthma



Oesophageal spasm, swallowing problems

Desensitization against triggers

Gastric secretion reduced by imagery

Habitual reflex vomiting

IBS (Whorwell, IBS Treatment Unit)

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Gastrointestinal DisordersGastrointestinal Disorders


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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.

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GutGut--Directed HypnotherapyDirected Hypnotherapy


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Erections & Irritable Bowel SyndromeErections & Irritable Bowel Syndrome



Stop inflammation and swelling

Reduce pain and distress

Debridement of tissues and changing dressings

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BurnsBurns


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Pain, anxiety, depression, feelings of hopelessness, side-effects

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

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CancerCancer



Nobody wants to hurt, and pain interferes with healing, soit 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

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Chronic PainChronic Pain


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Shown to be efficacious with headache and migraine

Relatively brief and cost effective

Virtually free of the side effects, risks of adverse reactions, andongoing expense

Hypnosis should be recognized by the scientific, healthcare, and medical insurance communities as being an

efficient evidence based practice.

Hammond (2007)

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Headaches & MigrainesHeadaches & Migraines


Esdaile (1957) reported 345 major operations performed inIndia 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)

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2

SurgerySurgery




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PhobiaPhobia

Dentistry

Spaces

Birds

Injections





Meta-analytic review of 18 articles and 27 effect sizes

indicated that hypnotic suggestions relieve pain for 75% of933 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.

Hypnotherapy With PainHypnotherapy With Pain

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Review by Brannon & Feist (2004) indicated effectiveness withheadache, cancer pain, burn pain, childbirth discomfort, dentalpain, surgery pain, low back pain, experimental pain, and pain

from sickle cell disease.

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Elkins et al. (2007) reviewed 13 studies, excluding studies ofheadaches, that compared outcomes from hypnosis for thetreatment 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 painproblems such as:

Cancer

Low back pain

Arthritis pain

Sickle cell disease

Temporomandibular pain

Disability-related pain18

8



Hypnosis is now the pain-control method of choice forinterventional radiological procedures at Harvard Medical

Schools Beth Israel Deaconess Medical Centre in Boston.Recoveries are faster, patients are more satisfied, and thehospital saves considerable sums of money while reducing

risk exposure.

Lang et al., 2000, Lancet, 355, 1486-1490

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YapkoYapko & Depression& Depression

Give a sleep tape in the first session

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Indications for HypnosisIndications for Hypnosis

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

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1



ContraindicationsContraindications

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

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Define self hypnosis

Teaching self hypnosis to clients

Therapeutic applications of self hypnosis in practice

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Self HypnosisSelf Hypnosis


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)

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Suggestive and insight oriented hypnotic approaches

Hypnosis indicated or contraindicated

Types of strategies or therapeutic goals

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Treatment PlanningTreatment Planning


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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

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Rapport

Degree of resistance

Locus of control

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Managing Resistance


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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

StrategiesStrategies

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Sources of Resistance

Patient

Therapist

Environmental

Source of ResistanceSource of Resistance

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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

Resistance to HypnosisResistance to Hypnosis

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Obtain the clients feedback, critique and discussion of whatinterfered with responsiveness

Recall of previous successful induction

Modeling a successful subject

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Advantages

Objective method of evaluating responsivity to hypnosis and whois likely to benefit

Gain info about hypnotic talents and boost therapist confidence

Modelling for clinicians in how to elicit phenomena

AdvantagesAdvantages

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Disadvantages

Tend to be directive and may result in objections

Provide only one sample of responsiveness (not alwayspredictive)

DisadvantagesDisadvantages

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Hypnotic Susceptibility Scales


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

Hypnotic Susceptibility TestsHypnotic Susceptibility Tests

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"The debate continues over just how useful clinical scales are intreatment. Their value in research is beyond question. However, itis unclear how relevant and responsive to standardized, therefore

not individualized, a test item is to eventual clinical resultsobtained."

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Susceptibility Assessment ToolsSusceptibility Assessment Tools


Barber

Stanford Hypnosis Susceptibility Scale

Hypnotic Induction Profile

HIP Modified

Susceptibility Assessment ToolsSusceptibility Assessment Tools

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A measurement tool and an induction

Hypnosis Induction ProfileHypnosis Induction Profile

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Ethics


Ethical and Legal Issues and standards of professional conduct

Certification requirements in Clinical Hypnosis

The unfolding of CFCH

Handouts

EthicsEthics

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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

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Integrating Hypnosis Into Practice


Examples

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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

Small Group PracticeSmall Group Practice


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Certificates Presented

Clinical (c) 2007 Hypnosis Leonard McEwen & Lynn Lambert

Documents

Transcript of Clinical (c) 2007 Hypnosis Leonard McEwen & Lynn Lambert