Hypnosis

Hypnosis isn’t just one thing, but describes a range of mental states in which one is receptive to suggestions. Stage hypnosis and clinical hypnosis aren’t the same phenomenon. There are a number of popular myths and misconceptions about hypnosis, and several models to explain hypnotic phenomena. I learned the basic techniques of hypnosis in grad school and practiced on friends. But since I never got certified as a hypnotist, I limited the use of hypnotic techniques in my clinical practice. I usually only did one “trance induction” per client, when it seemed appropriate, with the goal of teaching them self-hypnosis while they were “in a trance.” Outside of work, I’ve hypnotized friends at their request, for such things as pain relief.

I put quotation marks around trance because trance induction is only one model – the best known – for hypnosis; but no model is perfect for all occasions. (See my past post on the Model Muddle.) Traditional trance induction involves a verbal induction, which may start with something like “You are getting very sleepy . . . .”, sometimes accompanied by a visual stimulus such as a pendulum, whose motion the subject is told to follow with his eyes. But some verbal inductions suggest that the subject’s eyelids “are getting very heavy” and will soon shut. A technique called guided fantasy can also induce a trance, as can a well-told story.

Stage hypnosis is another thing entirely. The silly on-stage behaviors  of the “hypnotized” volunteers from the audience appear to be best explained by a social role model of hypnosis. This role-playing proceeds from one of the popular myths about hypnosis: that the hypnotist can control his “subject’s” behavior. Anyone who comes forward when the stage hypnotist invites volunteers is a wanna-be performer, predisposed to do whatever he’s told. The hypnotist “auditions” the crowd to see which people are the most suggestable, weeding out the less suggestable. The volunteers he selects to go on stage know they’re absolved of all responsibility for any silly  thing they may do, because they’re seen as being under the hypnotist’s control. He earns his paycheck before his subjects are on stage, because he knows the people he’s selected will act-out the role of hypnotic subject, as it’s popularly understood.

Some people are better hypnotic subjects than others, and clinical hypnotists have ways of assessing “depth of trance” before making therapeutic suggestions. They don’t exert control over the behavior of their clients, but help them harness the power of their imagination and will, to bring about desired changes in behavior. A good hypnotic subject is one who wants to experience a trance state, and expects something good to come from it – if only a feeling of relaxation. It helps if the subject thinks hypnosis can help them achieve a desired goal, such as pain control, quitting smoking, or losing weight.

A good subject can be taught self-hypnosis, and learns that any power she’d thought resided in the hypnotist in fact resides within herself. When a placebo pill works to relieve pain, it’s because the person taking it wants and expects it to – another example of how motivation affects perception. People can learn to use trance to re-direct their mind away from pain,  or from nicotine cravings. Naturally occurring events can  temporarily result in relief from pain. If you were flying in an airliner while you had a splitting headache, and the plane experienced extreme turbulence for two minutes and seemed to be falling out of the sky, it’s likely that you’d lose all awareness of your headache for those two minutes. If panic can re-direct the mind away from pain, so can other things.

Post-hypnotic suggestions can help people to change behavior, but there’s nothing magical about their power. A hypnotist working with a client on smoking cessation will give positive suggestions while he’s in trance, then may give post-hypnotic suggestions that he won’t feel like smoking after the session, and if he does smoke, the cigarette will taste terrible. What the hypnotist can’t supply for the client is willpower. If the client takes a puff after the session and throws the cigarette away because it tastes awful, this experience may help him to fight cravings and stop smoking. But if he resumes smoking despite the initial bad taste, the post-hypnotic suggestion quickly fades.

The only “magical” element of hypnosis is the magic of the human imagination. Hypnotic subjects don’t lose control in trance, and can’t be hypnotically forced to do things they don’t want to do. People can’t get “stuck” in trance. While positive hypnotic suggestions can help people marshal their inner resources to change chosen behaviors, there’s no truth to the notion that it can improve memory or sharpen the recall of details of past events. Indeed,  it can encourage the development of false memories.

In a later post I’ll be writing about Ericksonian hypnotherapy, which revolutionized our understanding – and the practice – of clinical hypnosis in the latter half of the twentieth century. Dr. Milton Erikson was a genius psychotherapist, whose influence on the profession is evidenced by the fact that the Milton Erikson Foundation sponsors the Evolution of Psychotherapy conferences – the world’s largest convocation of psychotherapists.

Metaphor and storytelling in therapy, Part 2

Throughout most of my mental health career I was blessed with good supervision. My first clinical supervisor was a PhD licensed psychologist, Dr. Robert Klein. He taught me a lot, including a procedure for helping enuretic children – bedwetters – to “keep a dry bed” when their families were trying to force them to “stop wetting the bed.” Using this procedure I was able to help several enuretic children to overcome their problem quickly. In one instance, it only took one session for a boy to immediately start keeping a dry bed. The procedure uses storytelling in two different ways, to role-model the desired outcome – as well as a family systems intervention.

This is the sequence I’d learned: After establishing some degree of rapport with the anxious and humiliated child, I’d tell him – in front of his parent(s) – a very brief generic story about “a boy your age” with the same problem, who’d gotten over the problem as quickly as it had started, after seeing a counselor. This provided a ray of hope for a child who desperately wanted to stop wetting his bed, but was clueless as to how to do it.

Then I’d do a family systems intervention, to change the family’s response to the problem, and to get the family to start promoting success, rather than punishing failure. I’d explain that the problem was caused by anxiety ( or “nerves”), and when the boy stopped worrying about bedwetting, it would stop. I’d instruct the parent(s) to stop shaming and punishing the child for “wetting the bed,” and encourage them to talk instead about “keeping a dry bed.” Any siblings should be instructed not to tease their brother. Once I felt confident that the parent(s) understood the plan and that the family would stop blaming and punishing their child, I’d speak to him individually.

By this time, the boy saw me as an ally, one who’d asked his family to stop shaming and punishing him, and who’d predicted quick success. I’d tell him, “There’s a part of your brain that never sleeps” (it’s called the reticular formation), and predicted that when his bladder got full when he was asleep, that part of his brain would wake him up, so he could go pee in the toilet. Then I’d ask him to name his favorite hero, so I could craft a story especially for him. If he said Spider-Man, I’d make up a story on the spot about Spider-Man defeating some supervillain, then going home. There Peter Parker would eat supper, pee, and go to bed. When his bladder got full in the middle of the night, he got up and peed in the toilet, and woke up after sunrise in a dry bed.

Somehow this simple story that models the desired behavior, using a role-model chosen by the child, helps him to be less anxious and to wake up when he needs to pee. In the case of my “one-session enuresis cure,” when I saw the boy’s mother weeks later, I asked her how he was doing and she told me he’d kept a dry bed since the day we met. I asked her how she understood what had worked for him, and she replied, “He said you’d told him that there’s a part of his brain that never sleeps.” Using metaphors and stories that predict success, and give the  client reasons to expect it, can be very effective in therapy.

Therapists who are good at storytelling can craft stories on the spot, or collect teaching stories and select the right one for the right client and situation. The following story, slightly modified, comes from therapist and author Bill O’Hanlon. It’s a good story to tell people whose lives are affected by phobias and irrational fears: The abbot of  a monastery had to go to town for the day, but he hesitated because every time he went away, the monks got into some kind of trouble. The monks urged him to go, promising to stay out of trouble, and not leave the monastery until he returned. So the abbot set out the next morning. Not long after he left, the monks heard a loud knock on the heavy oaken door to the great hall. One of them went and opened the door. He found himself facing a hideous, slimy demon, with a mouthful of fangs and claws like razors. The monk screamed and jumped back, and the demon entered. Other monks heard the screams and ran to the great hall, where they saw the demon menacing their brother and growing larger before their eyes.  They started screaming, too, and the demon grew even faster, towering above their heads.

When the abbot returned, he knew right away that the monks were in trouble again, because the door to the great hall was open, and he heard screaming inside. He entered, closing the door behind him. He saw the huge demon growling and menacing the monks, who cowered in a corner, trembling and screaming. Calmly, the abbot walked over to them, saying “Hi, demon” offhandedly as he passed him.  “Look” he said to the monks, “This demon eats your fear and it makes him grow, but he can’t hurt you. Ignore him.” Comforted by their abbot’s calm presence, the monks stopped screaming and stood up; and the demon started to shrink. Then, to their surprise, the abbot started laughing and telling jokes. Soon all the monks were laughing, and the demon continued to shrink until it was the size of a mouse – its actual size. It couldn’t leave because the door was closed, and the monks decided to keep it as a reminder not to let themselves be ruled by their fears. The abbot told them, “Fear cannot grow where there is heart and humor and laughter.”

If you’re a therapist or are studying to be one, I recommend Bill O’Hanlon’s website <billohanlon.com> as a gateway to a treasure trove of resources. He studied under Dr. Milton Erickson, one of the giants of psychotherapy, whom I’ll be writing about in future posts. Bill has written over 30 published books, and has written about how you can write and publish your book. I got the fear demon story from his CD of stories, “Keep Your Feet Moving: Favorite Teaching and Healing Tales.”