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Introduction to Clinical Hypnosis

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Title: Introduction to Clinical Hypnosis


1
Introduction to Clinical Hypnosis
  • Leonard McEwen, MSW, RSW
  • Alex Chisholm, BSC, PT

2
Sign In
  • Please remember to sign in for each session

3
Definitions, History Theories
4
Media Clip
4
5
Hypnosis Defined
  • 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

5
6
  • As a tool for health may have originated with
    Hindus of India
  • Sleep temples used suggestion to cure

6
7
Paracelsus (1493-1541)
  • Swiss
  • 1st to use magnetic healing

7
8
Valentine Greatrakes (1628-1666)
  • "the Great Irish Stroker"
  • Healed people by laying his hands on them and
    passing magnets over their bodies

8
9
Gassner (1727-1779)
  • Catholic priest
  • Believed that disease was caused by evil spirits
    and could be exorcised by incantations and prayer

9
10
Maximilian Hell (1720-1792)
  • Used magnets to heal by applying steel plates to
    the naked body
  • Franz Anton Mesmer was a student

10
11
Dr. Franz Mesmer (1734-1815)
  • 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 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

11
12
12
13
Abbé Faria
  • 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

13
14
Lucid Sleep
  • Concentration rather than animal magnetism
  • Involuntariness
  • Father of suggestion theory
  • Importance of the subject not the hypnotist

14
15
Marquis de Puységur
  • Student of Mesmer
  • First described and coined the term somnambulism

15
16
Récamier
  • 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.

16
17
James Braid (1705-1860)
  • 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 processthe 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

17
18
Dr. John Elliotson (1791-1868)
  • English surgeon
  • Reported numerous painless surgical operations
    using mesmerism in 1834

18
19
Dr. James Esdaile (1805-1859)
  • Reported on 345 major operations performed using
    mesmeric sleep as the sole anesthetic

19
20
Jean-Martin Charcot (1825-1893)
  • 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

20
21
Pierre Janet
  • 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.

21
22
Jean Charcol
22
23
July 28, 1847
  • 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."

23
24
Pope Pius XII (1956)
  • 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

24
25
American Civil War
  • 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

25
26
Ambroise-Auguste Liébault (1864-1904)
  • 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

26
27
1889
  • 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

27
28
Emile Coué (1857-1926)
  • French pharmacist
  • Laws of Suggestion

28
29
Sigmund Freud
29
30
Milton Erickson
30
31
Modern 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

31
32
Endorsements
  • Clinical hypnosis endorsed by the
  • British Medical Association (1955)
  • American Medical Association (1958)
  • American Psychiatric Association (1961)
  • American Psychological Association (1969)

32
33
Theories of Hypnosis
  • Neo-Dissociative
  • Social Pychological
  • Psychodynamic
  • Social Learning
  • Ericksonian Atheoretical Approach
  • Multidimensional Formulations

33
34
Hypnotic Response
  • 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

34
35
  • Cognitive, motivational and psychosocial
    variables (expectations, attidudes, motivations,
    compliance)
  • Interpersonal environmental variables (quality of
    relationship, percieved competance, trust,
    conducive environment)

35
36
Myths Misconceptions
37
Major Myths Misconceptions
  • Loss of control
  • Surrender of will
  • Loss of consciousness

37
38
  • 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.

38
39
  • 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.

39
40
  • 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.

40
41
  • 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.

41
42
  • 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.

42
43
Hypnosis vs. Relaxation
44
Hypnosis Relaxation is not necessary for hypnotic
induction. Relaxation Relaxation is being in a
relaxed state.
44
45
Hypnosis Hypnosis can produce analgesia and
anaesthesia. Relaxation Relaxation does not
produce analgesia and anaesthesia.
45
46
Hypnosis Hypnosis can significantly reduce or
abort acute pain. Relaxation Relaxation has no
significant effect on acute pain.
46
47
Hypnosis Major surgery tolerated under
hypnosis. Relaxation Major surgery cannot be
tolerated under relaxation.
47
48
Hypnosis Hypnosis prevents inflammation and
swelling in acute burn cases. Relaxation Relaxati
on does not suppress inflammation and swelling in
acute burn cases.
48
49
Hypnosis Hypnosis produces dissociation,
hallucinations and delusions. Relaxation Dissocia
tion, hallucinations and delusions occur as
epiphenomenon.
49
50
Hypnosis Hypnosis produces de-realisation and
depersonalization. Relaxation Derealisation and
depersonalization can occur.
50
51
Hypnosis Hypnosis induces dreams. Relaxation Drea
ms can occur.
51
52
Hypnosis Hypnosis produces trance
logic. Relaxation There is no trance logic.
52
53
Hypnosis Hypnosis can easily produce
amnesia. Relaxation Amnesia can occur by chance.
53
54
Hypnosis Somato-sensory changes easily produced
under hypnosis. Relaxation Somato-sensory
changes can occur as a function of
parasympathetic dominance.
54
55
Hypnosis Memory
  • Its imperfect nature
  • Trauma memory
  • Accurate recall
  • Forensics

55
56
Hypnosis Creation of Pseudomemory
  • 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

56
57
Assessment, Presenting Hypnosis
58
  • Standard Psych/Medical evaluations and
    diagnostics should be completed prior to using
    hypnosis
  • All hypnosis is really self hypnosis
  • Everyday trance
  • Everyday absorption experiences

58
59
Informed Consent
  • Name hypnosis dont 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

59
60
Hypnotic Phenomena
61
Media Clip
61
62
  • Research on phenomena associated with hypnosis
  • Suggestions for eliciting phenomena
  • Applications of hypnotic phenomena

62
63
Ideomotor Phenomena
  • Hands moving together
  • Eye closure
  • Ideomotor signals
  • Arm catalepsy, levitation
  • Autonomic movements
  • Finger lock
  • Eye catalepsy

63
64
Ideosensory Activities
  • Dissociation
  • Analgesia
  • Anasthesia
  • Hypnotic dreams
  • Post hypnotic suggestions

64
65
Hyperamnesia Age Regression
  • Partial regression
  • Revivification

65
66
Amnesia Time Distortion
  • Hidden Observer (ego-state phenomena)
  • Negative and positive hallucinations
  • Olfactory
  • Gustatory
  • Kinesthetic
  • Auditory
  • Visual

66
67
Frequency
  • Difficulty of facilitating phenomena
  • Classic suggestion effect of experiencing
    phenomena

67
68
Hypnotic Phenomena Demonstrated
  • Hands moving together
  • Eye closure
  • Ideomotor signals
  • Arm catalepsy, levitation
  • Autonomic movements
  • Finger lock
  • Eye catalepsy
  • Dissociation
  • Analgesia
  • Anesthesia
  • Hypnotic dreams
  • Post hypnotic suggestions

68
69
Induction, Re-Alerting Suggestions
70
Steps In Facilitating Induction
  • Importance of removing suggestions and realerting
    clients
  • 6 principles of induction and suggestion
  • 4 types of suggestions
  • Handouts

70
71
Facilitating Induction
  • Preparing and educating the client
  • Fixation of attention and deepening of
    involvement
  • Facilitating involuntary or unconscious
    involvement
  • Realerting

71
72
Hypnotizability
Title Page
73
Stages of Hypnosis
  • Advertising
  • Pre-Session
  • Waiting Room
  • Client Interview
  • Office Presentation
  • Induction
  • Deepening
  • Session
  • Alerting
  • Debriefing

73
74
Intentional Practice
  • Set the stage for hypnosis
  • Feed the clients expectation
  • Call for an appointment

74
75
Pre Session
  • Advertisement - CSCH Membership
  • Use of Hypnosis as an adjunct

75
76
Waiting Room
  • Brochures
  • Receptionist distributes client information form
    which includes hypnosis related questions

76
77
77
78
Client 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?

78
79
Office Presentation
  • Comfort
  • Subdued lighting
  • Music
  • Bathroom

79
80
80
81
Induction
  • Your Chair
  • Comfort
  • Head support
  • Your Technique
  • Voice
  • Pace
  • Your Office Finishing
  • Color
  • Comfort

81
82
Deepening
  • Voice and timing
  • Image
  • Sound

82
83
Session
  • Directive
  • Metaphor use
  • Post hypnotic suggestion

83
84
Example
  • Removing suggestion effects and realerting

84
85
Example
  • Rapport and cooperative relationship

85
86
Example
  • Creating positive expectancy

86
87
Emile Coué and the Laws of Suggestion
  • Coués 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.

87
88
Example
  • The principle of using positive suggestions

88
89
Example
  • Principle of trance ratification

89
90
Example
  • Value of careful observation

90
91
Example
  • Ericksons Principle of Individualization and
    utilization of clients interests, needs, talents
    and motivations

91
92
  • 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

92
93
Hypnotic Induction
  • Four basic induction techniques
  • Eye fixation
  • Arm drop
  • Hands moving together
  • Eye roll
  • Coin technique
  • Progressive relaxation
  • Imagery
  • Conversational

93
94
Hypnotic Susceptibility
  • Long Term Stability of Hypnotic Response
  • Genetic?
  • Trait involvement (dissociative)?
  • Situational and contextual variables
  • Burn victims
  • No one theory accounts for responsiveness

94
95
Responsiveness
  • Is responsivity modifiable?
  • Do efforts produce only compliance but not
    increase responsivity?
  • Age and responsiveness
  • Two populations with above average responsiveness

95
96
Personality Factors
  • 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

96
97
Imaginative Ability, Fantasy Proneness
Hypnotizability
  • 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 Hilgards, Personality and Hypnosis (1970)

97
98
  • 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

98
99
Absorption Hypnotizability
  • The capacity for absorbed and self-altering
    attention
  • Highly correlated with attention
  • See Tellegen and Atkinson, 1974

99
100
Expectancy Hypnotizability
  • Erickson was a master at combining psych and
    physiological phenomena into expectancy

100
101
Gender Hypnotizability
  • No difference
  • Spiegel and Spiegel 2004

101
102
Age Hypnotizability
  • Peaks early and slowing declines
  • Images not relaxation with children

102
103
Mental Status Hypnotizability
  • Depends upon researcher/writer
  • Note Yapko

103
104
Enhancing Hypnotizability
  • 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

104
105
Hypnotizable Clinical Populations
  • High (Affective/Mood)
  • Axis I
  • Dissociative/conversion
  • Dysthymia
  • MDD
  • Brief Psychotic
  • Axis II
  • Histrionic
  • dependant

105
106
  • Medium (Mixed)
  • Axis I
  • Impulse Control
  • Dysthymia
  • MDD
  • Bipolar
  • Axis II
  • Borderline
  • Antisocial

106
107
  • Low (Cognitive)
  • Axis I
  • OCD
  • Schizophrenia
  • Axis II
  • Paranoid
  • Schizoid
  • Schizotypal
  • OCD
  • Narcissistic
  • Avoidant

107
108
Suggestibility In Hypnosis
  • Openness to accept new ideas
  • Willingness to accept new information or
    perspectives
  • A focused capacity to translate ideas into
    suggested responses

108
109
Therapist 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)

109
110
Need for Acceptance
  • 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

110
111
Client Expectations
  • Self-fulfilling prophecy
  • The ideas that a person has about his future
    experiences will guide his or her current
    experiences in that direction

111
112
Client Need for Internal Harmony
  • 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

112
113
Effects 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

113
114
Examples
  • 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?

114
115
Need for Critical Thought
  • 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
116
Susceptibility - Biology or Learning
  • 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
  • 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)

116
117
Intelligence
  • No known correlation
  • Intelligence hypnotizability if this exists it
    might be due to ability to concentrate

117
118
Mental Status
  • Psychotics and hypnosis assumed in past to be
    poor but indirect work 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

118
119
Self-Esteem
  • 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

119
120
Fantasy Proneness, Imagination Hypnosis
  • Concrete or abstract
  • Concrete requires more detail
  • Factor in responsiveness
  • Factor in approach to use with the client

120
121
Clinicians Responsibility
  • Discover under what circumstances, internal and
    external, a person is most responsive to new
    information and suggested perspectives
  • Building
  • Therapeutic Alliance

121
122
Relationship 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

122
123
High Hypnotic Ability
  • Children (9-12)
  • Bulimics
  • PTSD
  • Dissociative disorders

123
124
Light Trance
  • Slow deeper breathing
  • Progressive feelings of lethargy
  • Observable relaxation
  • Inhibition of voluntary movements
  • Eyelid catalepsy
  • Limb catalepsy

124
125
Medium Trance
  • 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
126
Deep Trance (Somnambulism)
  • 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
127
Plenary Trance (Stuporous)
  • 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
128
Deepening
129
Deepening
129
130
Points to Remember
  • 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?

130
131
Points 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

131
132
  • Many of the deepening techniques can also be used
    for induction.

132
133
Methods of Deepening
134
Counting
5
3
1
4
2
  • Counting downwards (implying "going down" deeper
    into hypnosis) while offering suggestions of
    relaxation and come forward between numbers
  • Miller, 1979

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As If Method
  • 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

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The Stairs/Elevator Going Down
  • 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)

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Compounding/Chaining
  • 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")

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The Minds Eye Closure
  • 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 thinking and imaging as
    the induction progresses. With suggestions for
    the minds 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

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Silence
  • you can now have some quiet time to enjoy the
    experience of hypnosis."

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Posthypnotic Suggestions Re-Induction
  • 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
    clients ability to focus)

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Clients Experiences Office Situation
  • 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

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Fan
  • as the breeze from the fan touches you, you
    will go deeper and deeper into relaxation...

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Ring of A Phone
  • with each ring of the phone, you will find
    yourself drawn into your own special trance

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Rocking Chair
  • with each rock of the chair you will go deeper
    and deeper into your own hypnotic trance

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Other Deepenings
  • Clients breathing
  • Each time you exhale you will feel yourself drawn
    into a more and more relaxed state.

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Revolving Wheels Fantasy
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Patient Motivation Needs
Motorcycle Example
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Visual Imagery
  • 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.

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Metronome
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Self Hypnosis
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Benefits of Self Hypnosis
  • Between session change
  • Continuation of therapeutic focus
  • Long term maintenance
  • Situation or Crisis management

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Yapko and Depression
  • Give a sleep tape in the first session

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Applications
  • 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

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Teaching Self Hypnosis
  • In your office
  • Post Hypnotic Suggestion for trigger
  • Two fingers
  • Eyes closing
  • Others
  • Practice

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The Clients 6 Steps to Self Hypnosis
  1. Plan the suggestion before going into hypnosis
  2. Use your entry cue
  3. Count backward from 100-95 slowly, dont 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 dont think about or
    criticize the suggestion
  6. When count reaches 90 give the exit or alert cue

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Treatment Planning
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Applications
  • 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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Eyes Open Application
  • Work Environment
  • Before meetings
  • Stressful situations
  • Performance related situations
  • Other
  • Performance related (relationships, sports)?

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Habit Control
  • Nail Biting
  • Smoking
  • Weight
  • Others

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Phobias
  • Flying
  • Elevators
  • Others

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Dermatological Conditions
  • Anxiety, depression, shame, embarrassment
  • Reduce rubbing and scratching
  • Alleviation of warts
  • Pruritis
  • Acne, psoriasis

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Media Clip
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Asthma
  • Desensitization against anticipatory triggers,
    anxiety, panic
  • Suggestion of relaxation, ego-strengthening
  • Provoking and alleviating an attack (control
    training)

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Gastrointestinal Disorders
  • Oesophageal spasm, swallowing problems
  • Desensitization against triggers
  • Gastric secretion reduced by imagery
  • Habitual reflex vomiting
  • IBS (Whorwell, IBS Treatment Unit)

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Gut-Directed Hypnotherapy
  • 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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Erections Irritable Bowel Syndrome
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Burns
  • Stop inflammation and swelling
  • Reduce pain and distress
  • Debridement of tissues and changing dressings

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Media Clip
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Cancer
  • 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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Chronic Pain
  • 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

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Headaches Migraines
  • 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)

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Surgery
  • 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)

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Media Clip
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Phobia
  • Dentistry
  • Spaces
  • Birds
  • Injections

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Hypnotherapy With Pain
  • 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.

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  • 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.

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  • 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

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  • Hypnosis is now the pain-control method of
    choice for interventional radiological procedures
    at Harvard Medical Schools 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

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Yapko Depression
  • Give a sleep tape in the first session

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Indications 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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Contraindications
  • 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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Self Hypnosis
  • Define self hypnosis
  • Teaching self hypnosis to clients
  • Therapeutic applications of self hypnosis in
    practice

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  • 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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Treatment Planning
  • Suggestive and insight oriented hypnotic
    approaches
  • Hypnosis indicated or contraindicated
  • Types of strategies or therapeutic goals

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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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Strategies
  • Enhancement of insight
  • Abreaction or emotional facilitation
  • Perceptual change
  • Reduction or alteration of affect
  • Facilitation of behavioral change
  • Facilitation of physiological change

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Source of Resistance
  • Sources of Resistance
  • Patient
  • Therapist
  • Environmental

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Resistance to Hypnosis
  • 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

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  • Obtain the clients feedback, critique and
    discussion of what interfered with responsiveness
  • Recall of previous successful induction
  • Modeling a successful subject

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Advantages
  • 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

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Disadvantages
  • Disadvantages
  • Tend to be directive and may result in objections
  • Provide only one sample of responsiveness (not
    always predictive)

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Hypnotic Susceptibly Scale
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Hypnotic Susceptibility Tests
  • 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

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  • "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."

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Susceptibility Assessment Tools
  • Barber
  • Stanford Hypnosis Susceptibility Scale
  • Hypnotic Induction Profile
  • HIP Modified

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Hypnosis Induction Profile
  • A measurement tool and an induction

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Ethics
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Ethics
  • Ethical and Legal Issues and standards of
    professional conduct
  • Certification requirements in Clinical Hypnosis
  • The unfolding of CFCH
  • Handouts

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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
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Small Group Practice
  • 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

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  • Certificates Presented
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