Welcome to our series of brief case presentations sponsored by NYSEPH on the benefits of using hypnosis to treat a range of medical and psychological conditions.

Each case describes the problem/background, highlights specific hypnotic techniques and strategies used to address the problem, and reports the therapeutic outcome. The objective is not simply to showcase "successes" -some cases may describe difficult therapeutic challenges – but to develop a repertoire of innovative interventions that will enhance the expertise and effectiveness of the professional hypnotherapist.

If you are a member of NYSEPH and have a short case presentation or script you would like to share with others,
e-mail us at: .info@nyseph.org

The Case of Jennifer
Urinary Incontinence

The Case of Jennifer

Submitted 4/5/04 by Judith Grosz, CSW

Jennifer, a twelve-year-old girl I am treating, came to see me for help with intrusive thoughts, anger and depression. When Jennifer was five, her mother suffered an initial breakdown and her parents divorced. Since then, Jennifer has lived with her father and her older sister. For years, Jennifer had little contact with her mother, but one year ago her mother, who by then had a diagnosis of schizophrenia with major depression and several suicide attempts, tentatively initiated visits with Jennifer and her sister. During these visits, Jennifer noticed the scars on her mother's wrists. Jennifer continues to think about her mother cutting herself and is preoccupied with fear of her mother killing herself. She alternates between longing for emotional connection with her mother and feeling angry and distant from her. Her mother is unable to be empathic or emotionally available. Recently, Jennifer sang a solo with the school chorus. She was hoping that her mother would attend the performance. Her mother did come but left before it was over and Jennifer did not see her in the audience. During our session, Jennifer sat in my seat and suggested that she be the therapist and I be her. She began to ask me questions about my life in a very good imitation of me. Then, she decided to put me in trance (as we had previously done in our work) and asked me to see her mother in the audience during her performance. She asked me to describe her mother. I described her as smiling and clapping for Jennifer. She then asked me to see her mother cutting herself and asked me to describe what I saw . . . which I did. Next Jennifer wanted me to see the two images of her mother side by side on a double screen and to imagine the smiling mother tell the cutting mother to go away. She had me describe the cutting mother refusing to go away or stop cutting. Then she asked me to have the smiling mother tell the cutting mother to smile and be happy for her daughter. When the cutting mother wouldn't, Jennifer wanted me to make the cutting mother go away and leave her alone. But when I described the cutting mother's departure, Jennifer told me that she could not see it. All she could see was the cutting mother pushing both her and the smiling mother away.

Jennifer had difficulty retaining a positive image in her mind. My work with her focused on helping her use her creativity to envision other possibilities with her mother. I had Jennifer banish the cutting mother; I had her make the cutting mother become smaller and smaller. I also talked about how in my mind, I could make the mothers do anything I wanted them to do. For instance, one could be a caterpillar and the other the beautiful butterfly the first turned into. I demonstrated how I had my own internal video screen and could see any scenario I wanted. I could see myself getting a little bit bigger, for example, and as I grew older, my singing voice became stronger and more magnificent and I could smile with all of my friends, my sister, father, and grandparents. At the end of the session, Jennifer told me that she had a lot to think about.

Written by Judith Grosz, CSW, board member and instructor for NYSEPH.

NYSEPH CASE: Urinary Incontinence

Therapist: Suzanne Little, Ph.D.
Director, Mind/Body Program
Continuum Center for Health and Healing at Beth Israel Medical Center

Problem & Background:

Urinary incontinence is fairly rare in young women. Natalia, a tense, anxiously depressed woman of 27, reported urinary frequency (12-15 episodes daily) and urge incontinence worsening over 2 years. Even though genitourinary abnormality was ruled out and she believed her problem was anatomical, Natalia tried hard to comply with her urologist’s injunction to "resist the urge." No intervention – medication, homeopathy, acupuncture (for ‘quick bladder’) – completely helped. Natalia, who wore dark clothes to conceal the leaking, usually had the urge to void during stressful presentations. She would hold it in for the meeting’s duration, then "sprint" down a corridor to the office bathroom: "I can feel it dripping out in little spurts." Her "accidents" occurred mostly at work or on the subway. Our treatment was brief and symptom-focused (she had a therapist), but took into account exacerbating factors such as low self-esteem, performance anxiety, mood dysregulation, and a turbulent relationship with a domineering, older man whom she supported financially.

Hypnotic Interventions:

Hypnosis seemed an ideal approach, not only because it would help calm Natalia – she once told me, "I never ever feel completely relaxed" -- but because it could counteract the urologist’s recommendation to resist the urge, which, as a behavioral strategy, I felt, had undermined her confidence and efforts at self-control.

1. Conversational Trance – Initiating hypnosis; seeding for success

Confusional wordplay was used to induce a mildly dissociative state. The words – press/push (physical act associated with urination), pressure (emotional state), and impress/impressive (ideal state) – helped seed for successful transformation:

Th: I imagine you feel pressed at times to do things you don’t feel like doing.

Pt: What do you mean?

Th: Like pushing yourself to perform at work …

Pt: I do resent it, especially last minute presentations . . . [irritably] They just expect me to drop everything! [Pause] It isn’t any pressure I don’t already put on myself.

Th: I wonder if you can consider feeling less pushed to press yourself, is that possible? ... You can even impress yourself about the ways you can function without pressure, can you not?... And if there were less pressure you might flow …more freely…more comfortably...and that would be impressive .

Pt: [Musingly] I used to run after work. It calmed me. Maybe I should get back into that.

2. Storytelling – Setting the Pace

I built on the jogging theme by telling a story about a long distance runner–a woman marathoner -- famed for running laps to build special qualities of endurance. Each lap represented a "milestone" (e.g., inner resource) to help her gain her stride: This is a lap for strength . . . this is a lap for stamina…(uttered in a monotone to which she responded with a slight rocking) . . this is a lap for patience . . . The running culminated in a "victory lap," where she, as winner, could enjoy the feeling of a "runner’s high" -- a pleasing kind of mind/body flow . .

3. Juxtaposition of Urge and Urgency – Gaining Control

Natalia’s tension and anxiety remained a stumbling block. One day she was very upset about a fight with her boyfriend, and wondered if fighting aggravated her urinary problem. She asked why she always felt "in crisis." Her urgency became a useful device to help reframe her inner state:

Therapeutic Outcome:

The hypnosis took about 8 sessions. By the 4^th visit, she noticed a difference – fewer urinary episodes, increased assertiveness with her boyfriend. She had responded to a previous posthypnotic suggestion: If you hold back less, you can let go more. She bought herself a cream-colored suit "to wear when I’m better," and sat through an entire movie going to bathroom only once. In the next visit she made a major presentation to her corporate group without experiencing strain, and maintained her composure when the projector malfunctioned and she had to ad lib without slides. Afterwards she went to the bathroom without rushing: She took her time. Shortly after that, she reported over 80% reduction in symptoms and, a few visits later, said her problem was almost completely resolved.

Submitted: 2/14/03