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Title: Hocus Pocus: What are the Ethical Issues Involved in


1
Hocus Pocus What are the Ethical Issues Involved
in Utilizing Self-Hypnosis as a Stress Management
Strategy?
  • CEDER 2010
  • Kathleen Jones-Trebatoski, Ph.D., LPC-S, NCC
  • kajtrebatoski_at_stx.rr.com
  • Mary Louise Holt, Ph. D., LPC

2
Presentation Agenda
  • Stress
  • Nature, Myths, Misperceptions
  • Hypnotic Phenomena Treatment Planning
  • Principles and Process of Hypnotic Induction
  • Demonstration and Practice
  • How to Formulate Suggestions
  • Demonstrate the Importance of Self-Hypnosis
  • Ethical Principals of ASCH and Process of
    Certification
  • Application of Hypnosis to Psychological Disorders

3
Stress Management
  • Managing stress involves the increased self
    awareness of your personal reaction to stress and
    building your sense of control and mastery over
    the stressors in your life
  • Stress is an everyday fact of life . You cannot
    avoid it.
  • Stress is a change to which you must adapt,
    ranging from the extreme negative to the most
    euphoric.
  • It is how you respond to these experiences that
    determine the impact stress will have on your
    life.
  • (Davis,M., Eshelman, E., McKay,M., 2000).

4
Coping with Stress
  • There are numerous research studies dedicated to
    stress management.
  • Some recommendations have been to review the
    support network, to attend stress management
    workshops, and to develop ones spirituality.
  • (Smith, R., Maroney, K., Nelson, K., Able,
    A., Able, H., 2006).

5
Stress of being in the Educational System
  • Stressors include finances, careers that are
    currently in place, community issues, family
    issues, and significant relationship issues which
    create barriers to learning and success rates.
  • Stress becomes a constant, and too often a
    destructive, force.
  • Psychological stress can be observed in poor
    concentration, reduced motivation, frustrated
    learning and performance anxiety.
  • Physical stress can include disruptive sleep
    patterns and weaken immune systems.
  • (Smith, R., Maroney, K., Nelson, K., Able,
    A., Able, H., 2006).

6
Some Negative Psychological Effects of Stress
are
  • Anxiety
  • Depression
  • Lowered Self-esteem
  • Exacerbation of Chronic Pain

7
Some Negative Psychological Effects of Stress are
  • Backaches
  • Headaches
  • Heart attacks
  • Colds
  • Ulcers
  • Diarrhea
  • Constipation
  • Angina

8
  • According to reports from the Center for Disease
    Control and Preventions National Center for
    Health Statistics (NCHS) the 2004 preliminary
    mortality data for the United States shows that
    the 15 leading causes of death in the United
    States for the calendar year of 2004 were
  • Diseases of the heart (heart disease)
  • Malignant neoplasms (cancer)
  • Cerebrovascular diseases (stroke)
  • Chronic lower respiratory diseases
  • Accidents (unintentional injuries)
  • Diabetes mellitus (diabetes)
  • Alzheimers Disease
  • Influenza and pneumonia
  • Nephritis, nephritic syndrome and nephrosis
    (kidney disease)
  • Septicemia (blood poisoning, esp. that caused by
    bacteria or their toxins)
  • Intentional self harm (suicide)
  • Chronic liver disease and cirrhosis
  • Essential (primary) hypertension and hypertensive
    renal disease (hypertension) (high blood
    pressure)
  • Parkinsons disease and
  • Pneumonitis due to solids and liquids
  • Many of these top 15 causes of death are
    stress-related illnesses where stress can either
    be the causative factor or a contributing factor
    to the illness. Blonna (2005), Greenberg (2004),
    and Jones and Bright (2001)

9
  • Self-hypnosis is the fundamental nature of
    mind-body connection, enabling the mind to direct
    the body how to respond and adjusting the
    messages the body sends to the brain and
    modifying how they will be interpreted (Rossi,
    1986).
  • The professional organizations for counselor
    educators encourage support for reducing effects
    of stress for counselors and counseling students.
    However, masters level counseling programs may
    be lacking in the development of student wellness
    programs (Frame Stevens-Smith, 1995).
  • Frame Stevens-Smith (1995) emphasized the need
    to be concerned about the impairment of the
    student and the impairment of current counselors
    leading to the decreased quality of services to
    clients.

10
Hypnosis Myths and Misperceptions
  • 1. Fear of loss of control, surrender of will, of
    being dominated
  • 2. Losing consciousness/having amnesia
  • 3. Being influenced against their will
  • 4. Contaminating memory and producing false
    memory (hypnosis is not a truth serum)

11
Nature, Myths Misperceptions
  • History of Hypnosis
  • Known since the existence of time
  • Practiced through out the centuries since the
    time of Egypt
  • Franz Mesmer considered to be the modern inventor
    of hypnosis(1734-1815)
  • Techniques included staring into his patients
    eyes and making hand movements over their bodies.
  • Minimal verbal suggestions
  • Olness, K. Kohen, D., (1996). Hypnosis and
    Hypnotherapy with Children. New York Guilford
    Press

12
Early Uses of Hypnosis
  • John Elliotson (1791-1868)
  • English physician who was influenced by
    mesmerism.
  • The Zoist, 1842
  • Numerous Cases of Surgical Operations Without
    Pain in the Mesmeric State (1843)
  • Olness, K. Kohen, D. (1996).

13
Early Uses of Hypnosis
  • James Braid (1795-1860)
  • English Surgeon
  • Discarded mesmerism
  • Coined hypnosis from the Greek word hypnos,
    meaning sleep
  • Abandoned hand passes and instead, required his
    subjects to fix the gaze on an object and
    concentrate on a single idea
  • Olness, K. Kohen, D. (1996).

14
Early Uses of Hypnosis
  • Jean-Martin Charcot (1835-1893)
  • A French neurologist
  • Gave hypnosis a new measure of respectability
  • Hypnosis as a pathological state, a form of
    hysterical neurosis
  • Olness, K. Kohen, D. (1996).

15
Early Uses of Hypnosis
  • School of Nancy devoted to the investigation of
    hypnosis.
  • Freud (1883) incorporated hypnosis into practice
    but became disenchanted with results and stopped
    its use in 1896.
  • Olness, K. Kohen, D. (1996).

16
Early Uses of Hypnosis
  • Clark Hull (1930s) stimulated the reuse of
    hypnosis.
  • Benjamin Rush (1930s) utilized hypnosis.
  • World War I shell shock
  • World War I and World War II, use of
    self-hypnotic anesthesia as a means to get
    disabled soldiers back on the battle field.
  • British Medical Association endorsed hypnosis
    in1955.
  • American Medical Association endorsed hypnosis
    in1958.
  • American Psychological Association endorsed
    hypnosis in 1969.

17
Early Uses of Hypnosis
  • Milton H. Erickson, M.D.
  • Foremost hypotherapist of the twentith century
  • Erickson described hypnosis as a valuable
    therapeutic tool for enhancing a clients
    self-awareness and for facilitating therapeutic
    communication.
  • A means by which the client can have
    responsibility for self healing from emotional or
    physical pain. For the client to build on their
    own internal resources that otherwise may be
    ignored or overlooked.
  • Havens, R. Walters, C. (1989).
    Hypnotherapy Scripts, A Neo-Ericksonian Approach
    to Persuasive Healing. New York Brunner/Mazel,
    Publishers.

18
Early Uses of Hypnosis
  • Milton H. Erickson, M.D.
  • The unconscious mind is not the repressed
    unconscious described by Freud or the collective
    unconscious of Jung.
  • Erickson used the term unconscious mind to refer
    to all of the cognitions, perceptions and
    emotions which occur outside of a persons normal
    range of awareness.
  • That the unconscious mind has more resources and
    a better sense of reality than the conscious mind
    that must act as a filter.
  • Havens, R. Walters, C. (1989).

19
Early Uses of Hypnosis
  • Erickson became the founding leader and first
    president of the American Society for Clinical
    Hypnosis and the founding editor of its journal.
  • That the subtle hypnotic suggestions are based in
    person-center approach.
  • Gunnison, H. Renick T (1985)

20
Hypnosis in General
  • Utilized by mental health and medical
    professionals alike
  • Characterized by a state of attentive, receptive
    concentration containing three concurrent
    features of varying degrees
  • Dissociation
  • Absorption
  • Suggestibility
  • Procedure during which changes are suggested in
  • sensations,
  • perceptions,
  • thoughts,
  • feelings or behavior that promote healing
  • explore causes of symptoms

21
Hypnotic Phenomena Treatment Planning
  • Amnesia
  • Amnesia
  • Hypermnesia
  • Induced Dreams
  • Ideosensory Activities
  • Depersonalization

Phenomena of Hypnosis
  • Hallucinations
  • Time Distortion
  • Hyperesthesia
  • Somnambulism
  • Dissociation
  • Age Regression
  • Analgesia
  • Anesthesia
  • Ideomotor Activity
  • Exploration
  • Age Progression

22
Utilizing Hypnotic Phenomena in Treatment
Planning
  • Hypnosis Fact
  • Not a strategy or therapy by itself
  • Purpose of treatment tools
  • shortens the length of time in therapy,
  • helps control symptoms stress management
    techniques,
  • encourages self responsibility,
  • decreases therapist codependency
  • encourages independent living

23
Cooperative Venture
  • Dual process
  • learn about your clients personality, interests
    and hobbies while building rapport will only add
    to the individuation of the hypnotic experience
  • Conscious reframing
  • change clients belief system about the problem
    from complex to simple

24
Principles of Hypnotic Induction
  • Positive Wording
  • Imagery as well as Suggestion
  • Make Suggestions Flexible
  • Allow time for change
  • Repetition through synonymous words and phrases
  • Avoid Suggestions that Imply Failure or Doubt

25
The Process of Hypnotic Induction
  • One
  • Assessment Establishing Rapport
  • Two
  • Orienting the Patient
  • Three
  • Fixation of Attention Deepening Involvement
  • Four
  • Facilitating Unconscious (Involuntary) Response
  • Five
  • Trance Ratification
  • Six
  • Removing Suggestions
  • Re-Alerting the Patient

26
Types of Hypnotic Inductions
  • Eye Fixation Induction
  • Progressive Relaxation Induction
  • The Catalepsy Induction
  • The Arm Levitation Induction
  • The Coin Drop Technique
  • Rapid Eye Roll Induction

27
DEMONSTRATION
  • Progressive Relaxation Induction
  • Eye Fixation Induction

28
How When(to formulate suggestions)
  • Must have the attention of the client when giving
    the suggestions.
  • Client must be motivated to experience extreme
    relaxation.
  • Client should have motivation to overcome the
    concern (It is possible to increase motivation by
    suggestion).
  • Suggestions should be worded simply (Sentence
    structure should be simple to lessen the
    opportunity for misunderstanding).
  • Be clear in your own mind about the purpose of
    the given suggestion.

29
How When (to formulate suggestions)
  • The suggestion should be repeated.
  • In most cases a suggestion should be phrased so
    that a definite time is not indicated.
  • The client should be led into a compliant,
    positive attitude before the specific suggestions
    are given.
  • Use positive, rather than negative suggestions.
  • Demonstrate a persuasive and confident attitude.
  • Whenever possible make an implied contract with
    the client to carry out a suggestion.

30
How When(to formulate suggestions)
  • Suggestion should not be given until you
    determine that the client is in a hypnotic or
    very relaxed state.
  • Suggestions should be fitted to the client.
  • Make suggestions permissive rather than
    commanding (Avoid must, should etc.)
  • Minimize the use of the word try.
  • Use visual images to enhance suggestion.
  • Limit goals.

31
How When(to formulate suggestions)
  • Avoid ambiguity.
  • Vary verbal delivery of suggestions by
  • alteration in voice volume.
  • change in pace.
  • stress key words.
  • change in inflections and modulation of voice.
  • Give only one suggestion at a time.
  • Make suggestions refer to immediate future to
    allow time for them to be absorbed and acted
    upon.
  • Create suggestions that use as many senses as
    possible.

32
Phrasing for Hypnotic Suggestions
  • And you can be pleased...
  • It's very positive and comforting to know
  • ... in a way that meets your needs...
  • I wonder if you will enjoy how naturally... how
    easily...
  • One of the things I'd like you to discover is...
  • I want you to notice something that's happening
    to you...
  • Maybe it will surprise you to notice that...
  • Its very rewarding to know that...

33
Phrasing for Hypnotic Suggestions
  • I wonder if you will enjoy how naturally... how
    easily...
  • I'd like you to begin allowing...
  • Your unconscious mind can enable you to...
  • Give yourself the opportunity (to see if)_______
  • Perhaps sooner than you expect...

34
Demonstrate Process and Importance of
Self-Hypnosis
  • Advanced Self-Hypnosis

One Plan the suggestion first and keep it
positive Two Entry Cue Three Neutral
Imagery Four Move to suggestive imagery
  • Five
  • Return to Neutral Imagery
  • Six
  • Re-orient
  • Seven
  • Post-Hypnotic suggestion for post-trance feeling
  • Eight
  • Exit Cue

35
Ethical Principles of American Society of
Clinical Hypnosiswww.ASCH.net
  • Process of Certification
  • MD, DDS, DMD, DO, DPM, PhD, PsyD
  • Masters degree in the health field
  • Hold valid state licensure for independent
    practice
  • 40 hours post-degree, ASCH approved education
  • 20 hours of beginning trining
  • 20 hours of intermediate training
  • 20 hours of individual training with an ASCH
    approved consultant
  • 2 years of independent practice using hypnosis

36
AMERICAN SOCIETY OF CLINICAL HYPNOSIS (ASCH)CODE
OF CONDUCT
  • Introduction
  • The ASCH Code of Conduct is comprised of two
    sections, Ethical Principles and Ethical
    Standards.
  • The Ethical Principles serve as philosophical
    guidelines that help to structure a members'
    practice of hypnosis.
  • The Ethical Standards serve as practical or
    applied guidelines for the members' practice.
  • Members should take adequate measures to
    discourage, prevent, expose, and correct
    unethical conduct of colleagues. Additionally,
    members should be equally available to defend and
    assist colleagues unjustly charged with unethical
    conduct.

37
AMERICAN SOCIETY OF CLINICAL HYPNOSIS (ASCH)CODE
OF CONDUCT
  • Ethical Standards
  • I. ASCH members uphold the professional
    standards, ethics, and codes of conduct of their
    primary discipline.
  • II. ASCH members remain in good standing in the
    association or society that oversees the member's
    primary discipline.
  • III. ASCH members maintain a license to practice
    at the independent, unrestricted, or unsupervised
    level.

38
AMERICAN SOCIETY OF CLINICAL HYPNOSIS (ASCH)CODE
OF CONDUCT
  • Ethical Principles
  • I. Competence Members strive to attain the
    highest levels of professional competence.
  • 1. A. members use hypnosis in the treatment of
    patients only within the bounds of their training
    and expertise within their primary discipline
    and within the context of a professional
    relationship
  • 2. A "professional relationship" is defined by
    the members primary discipline and includes
    consultation or supervision of colleagues.
  • B. members expertise is determined, in part, by
    their professional education, training,
    licensure, and experience
  • C. members recognize, and are respectful of, any
    limitations to their expertise
  • D. members strive to maintain current knowledge
    of research, issues, and methods in hypnosis
  • 1. members participate in continuing education
    activities.

39
AMERICAN SOCIETY OF CLINICAL HYPNOSIS (ASCH)CODE
OF CONDUCT
  • II. Professional Responsibility Members serve
    the best interests of their clients or patients.
  • A. members accept responsibility for the care of
    their clients or patients consistent with their
    discipline and licensure
  • B. members seek out consultation and/or
    supervision when in doubt regarding their
    clinical practices or when questioned by others
    about their clinical practice
  • C. members participate and cooperate with
    inquiries regarding their practices
  • D. members accept responsibility for, and when
    necessary the consequences of, their behavior
  • E. members accept responsibility to monitor and
    make appropriate changes in their practice to
    comply with the Ethical Principles or Ethical
    Standards of this Code
  • F. members seek to educate the public about the
    proper and scientific use of hypnosis.

40
AMERICAN SOCIETY OF CLINICAL HYPNOSIS (ASCH)CODE
OF CONDUCT
  • IV. ASCH members do not support the practice of
    hypnosis by laypersons.
  • A. The "practice of hypnosis" means the provision
    of services, or the offer to provide services,
    utilizing hypnosis to individuals or groups
    regardless if a fee or honorarium is charged,
    offered or paid.
  • B. A "layperson" is
  • 1. an individual lacking professional education
    and clinical training in a
  • health care discipline, including but not
    limited to those recognized by ASCH for
    membership and/or certification,
  • or
  • 2. an individual not pursuing a degree from a
    regionally accredited institution, in a health
    care discipline including but limited to those
    recognized by ASCH for membership and/or
    certification.
  • C. Except as authorized by Sections V. B and C
    below, members do not provide hypnosis training
    to laypersons.

41
AMERICAN SOCIETY OF CLINICAL HYPNOSIS (ASCH)CODE
OF CONDUCT
  • V. Public and Media Presentation
  • A. ASCH members do not use or endorse or assist
    in the use of hypnosis for entertainment
    purposes.
  • B. Electronic recordings may be prepared by
    members for private patient treatment. Electronic
    recordings may also be prepared for purchase by
    health care professionals and/or the general
    public, but only for the purpose of educating
    individuals about the proper and scientific use
    of hypnosis, or to teach individuals who are not
    the member's patient/client the use of
    self-hypnosis for his or her own private use.
  • C. When members appear in public forums, such as
    on television or some other electronic format,
    they take care to ensure that any demonstration
    of hypnosis is done in such a way as to prevent
    or minimize risk to unknown audience
    participants.
  • D. ASCH members ensure when they present
    hypnosis, in any format, to the public the member
    does so within the spirit of this Code and within
    the guidelines of their primary discipline.
  • E. Members honestly and fairly represent their
    professional competency, qualifications and
    capabilities

42
AMERICAN SOCIETY OF CLINICAL HYPNOSIS (ASCH)CODE
OF CONDUCT
  • VI. Nothing in this Code shall prohibit members
    from
  • A. teaching hypnosis to individuals or groups
    who, upon completion of such training, would be
    eligible for ASCH membership,
  • B. teaching students of health care disciplines,
    including but not limited to those recognized by
    ASCH for membership and/or certification,
  • C. teaching patients or clients the use of
    self-hypnosis for that individual's own
    therapeutic use, or
  • D. teaching about hypnosis in any forum that
    serves to properly educate and inform the
    consumer or professional public about hypnosis.

43
AMERICAN SOCIETY OF CLINICAL HYPNOSIS (ASCH)CODE
OF CONDUCT
  • VII. When ASCH members engage in human subjects
    research, they do so within the accepted
    standards of their primary discipline, taking
    precautions not to cause emotional or physical
    harm to their subjects.
  • VIII. When this Code is unclear on an issue,
    question, or complaint and when deemed
    appropriate by the ASCH Executive Committee,
    guidance is sought from the ethical standards of
    the member's primary discipline professional
    association and/or the member's licensing board.

44
AMERICAN SOCIETY OF CLINICAL HYPNOSIS (ASCH)CODE
OF CONDUCT
  • Enforcement
  • I. Any person, whether or not a member of ASCH,
    may initiate a charge of ethical violation
    against a member of ASCH.
  • II. Any charge must be submitted in writing to
    the Ethics Committee, must specify the time and
    place of the violation, and must be signed by the
    complainant.
  • III. The Ethics Committee shall inform the member
    in writing of the charges against the member and
    solicit the members response to the charges.
  • IV. If, upon receiving the response of the
    member, the Ethics Committee determines that
    cause for further inquiry exists, the Ethics
    Committee shall set a time and place for a
    hearing and shall notify the member and the
    complainant, by certified mail, of the time and
    place.
  • S\ASCH\Ethics\code of conduct-amended_2009.wpd

45
AMERICAN SOCIETY OF CLINICAL HYPNOSIS (ASCH)CODE
OF CONDUCT
  • Enforcement
  • VI. No later than thirty days following the
    hearing, the Ethics Committee shall submit a
    report of its findings to the Executive Committee
    and recommend either
  • A. dismissal of the charges,
  • B. censure or warning,
  • C. suspension, or
  • D. expulsion.
  • The Ethics Committee shall send by certified mail
    a copy of its report and recommendation to the
    charged member.
  • S\ASCH\Ethics\code of conduct-amended_2009.wpd

46
Dangers of Hypnosis
  • Amateur Operators
  • Entertainment Uses
  • Forgetting to Remove Suggestion
  • No significant dangers with hypnosis per se, only
    person using it!

47
Application of Hypnosis to Particular Concerns
  • Pain Management
  • Anxiety
  • Depression
  • Ego-Strengthening
  • Scripts can be designed to aid in your treatment
    plan when focusing on a particular disorder

48
Pain Management
  • Purpose
  • To alleviate cases of acute pain
  • To remove pain under four main conditions
  • Surgery
  • Terminal Patients
  • Acute pain in obstetrical and dental patients
  • Phantom Limb pain
  • Cautionary Note Leave signal pain for
    prevention of injury
  • Method
  • Direct or Indirect Suggestions
  • Use of Imagery

49
Pain Management
  • Target Population
  • People who experience chronic or acute pain
  • Those who do not wish to be under anesthesia
  • Strategies Techniques
  • Anesthesia or Analgesia Through Suggestion
  • Time or Body Dissociation
  • Dissociation of Body Parts
  • Displacement of Pain

50
Is It OK To Remove All Pain?
  • What is the function of pain
  • Four Situations when all pain maybe removed
  • Terminal illness
  • Child bearing labor
  • Phantom pain
  • Surgery

51
Anxiety
  • Purpose
  • To decrease level of anxiety
  • To enhance general coping abilities and effective
    living
  • To minimize anxiety and worry
  • Method
  • Direct or Indirect Suggestions
  • Use of Imagery
  • Target Population
  • People who experience panic, phobias and other
    related symptoms
  • Strategies Techniques
  • Progressive Relaxation

52
Depression
  • Purpose
  • To alleviate feelings of unhappiness, fatigue, or
    depressive moods
  • Cautionary Note Not useful with severe
    clinically depressed or suicidal
  • Method
  • Direct and Active Suggestions
  • Use of Suggestions that will motivate client to
    interact with environment
  • Target Population
  • People who experience feelings of dissatisfaction
  • People that are unmotivated
  • Strategies Techniques
  • The Affect Bridge
  • Crystal Ball Technique

53
Ego Strengthening
  • Purpose
  • To increase the clients sense of self-efficacy
  • To enhance general coping abilities and effective
    living
  • To minimize anxiety and worry
  • To enhance self esteem
  • Method
  • Direct or Indirect Suggestions and Metaphors
  • Age regression to happy and positive life
    experiences
  • Age progression and mental rehearsal
  • Use of trance ratification to demonstrate to the
    client the power of his or her own mind and
    potential

54
Ego Strengthening
  • Target Population
  • Generally indicated for all clients
  • A Flexible, Generalized Ego-Strengthening
    Technique
  • Physical Relaxation, using breathing or other
    method
  • Mental Calmness, using imagery such as a still
    pond
  • Disposing of mental obstacles, using imagery such
    as rubbish being dumped down a chute
  • Removal of barrier representing all self-imposed
    obstacles in the life of the client, using
    imagery such as a wall or fence made up of
    representations of those obstacles
  • Enjoyment of a special place where client feels
    content, tranquil, and at peace, where the client
    imagines self as able to do what they want or
    need to do

55
Contact Information
  • Mary Louise Holt, Ph. D, LPC
  • Professor
  • Texas AM University-Corpus Christi
  • Emailmary.holt_at_tamucc.edu
  • Kathleen Jones-Trebatoski,Ph.D., LPC-S, NCC
  • Private Practice
  • Emailkajtrebatoski_at_stx.rr.com

56
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