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Each case describes the problem and 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. There are also examples of metaphors and stories that can be very effective for a variety symptoms and problems. If you are a member of NYSEPH and have a short case presentation, metaphor or article you would like to share with others, Ernest R. Hilgard's Neo-Dissociation Theory Written by Giulio Bianco In the middle of the 1970’s, Ernest R. Hilgard presented his neo-dissociation theory. He theorized that the dissociation necessary for experiencing hypnotic phenomena may be attributable to a general capacity for dissociation that could be possibly be measured and observed outside of the customary domain of an hypnotic state. Essentially, the hypnotic induction is said to divide the functioning of the executive control system (ECS) into different 'rivers'. The theory basically proposes that hypnotic phenomenon are produced through dissociation within a high level of control systems. · In the late 70s, experiments which used several types of operational definitions and interesting tasks where conducted with the purpose of capturing a wide range of results. · The performances of over 100 undergraduates on clerical-motor and cognitive tasks in selective attention and divided attention conditions, as well as the degree of incidental learning, were correlated with scores on the Harvard Group Scale of Hypnotic Susceptibility. · The results unfortunately did not fully support the neo-dissociation theory despite the study's respectable convergent-discriminant validity. Conceptual and methodological considerations were noted and the results did indicate an important limitation of the explanatory power of E. R. Hilgard's neo-dissociation theory. Ernest Hilgard's neo-dissociation theory (1977) has been influential in the explanation of the hypnotic phenomena; the theory asserts that several distinct states of consciousness or altered states of consciousness can be present during hypnosis, such that certain actions may become dissociated from the conscious mind. In the late 70s, new theories suggested that the subject could still respond to hypnotic suggestions, while not consciously aware of the process because of an “amnesic barrier”. Hilgard's theory was inspired and characterized by experiments with the so-called 'hidden observer' phenomenon, whereby a 'hidden part' of the mind of a subject experiencing suggested hypnotic analgesia could be also encouraged to elicit reports of the 'true' pain experience. The hidden observer remains a controversial concept and is still the topic of investigation by professionals. The concept of the hidden observer that tries to show the presence of conscious and unconscious executive systems in hypnosis is controversial. Hilgard’s ideas of an 'amnesic barrier' and the 'hidden observer' do not fit comfortably with cognitive or physiological/psychological models. · Hypnosis, as we know, is characterized by changes in brain function. The most modern hypnotic model is described in three stages or parts, each with its own unique and characteristic pattern of brain activity. Like some of the other dissociation theories, changes in the way the attentional control systems function under hypnosis renders the patient more receptive and susceptible to the therapist suggestion. In the first stage of a typical induction, the subject normally pays close attention to the words of the hypnotherapist. Specific activity is increased in predominantly left-sided frontal-limbic brain regions. In the second part, the subject 'drifts and loses' part of the controlled attention and gives control to the therapist. In this second stage there is a proven reduction in left frontal activity. The third part notes an increase in right-sided temporal-posterior systems as the patient engages in passive imagery. By exhausting their frontal abilities during the induction, the highs end up frontally impaired in a hypnotic state. These recent hypnotic models find some support from behavioral and neuropsychological research and are complemented by several other state-like accounts of hypnotic functioning. · Hilgard's neo-dissociation theory (1977) has been influential in the explanation of the hypnotic phenomena. In conclusion, the theory asserts that several distinct states of consciousness can be present during the hypnosis session. Certain actions may become dissociated from the conscious mind. In the late 19th century, hypnosis was used by a large number of medical practitioners, who found that individuals susceptible to hysteria were highly suggestible to suggestion and could be put into deep trances, sometimes leading to a cure. In more recent years, hypnosis has been widely used as an aid in medical practice and psychotherapy. Hypnosis is also used in some criminal investigations, to help defendants to recall key events they might not be otherwise remembered. DETERMINATION Mullen was one of my favorite pets of all time. I had him when I lived in the Hollywood Hills many years ago. He would walk with me and friends on short hikes up toward the famous Hollywood sign which was near my home. He’d never run off on these walks but just enjoyed the human companionship. After I’d lived in Hollywood for a few years, I realized I needed to get more nature back into my life and less smog, so I made a Firm Decision to move to Washington State because I had spent time there before and really loved it. I was totally determined to make this happen, so before long I went on an expedition to find the right property, bought 10 acres of forest with some open land for having a huge vegetable garden and came back to Hollywood to sell my car and buy a pickup. I built a fairly high makeshift covering over the bed of the pickup out of plywood, and covered it with a type of water-resistant fabric. Then I began to pack up my belongings, which took almost two weeks. Since, like most cats, Mullen didn't like traveling in a vehicle, I built a special, large, very strong cardboard box for him with some fluffy pillows and enough small air holes so he would have plenty of fresh air to breathe. Anyway, the day arrived that we needed to head for Washington but he was nowhere to be found. I looked for a couple of hours and it seemed that even the old food can tricks to get his attention didn’t work to make him come running. Finally I spotted him when he poked his head up from an ivy patch across the street where he was hiding.
In some mysterious way he knew it was moving day that very day and he knew he didn’t want to go……but I of course, wasn’t about ready to leave my wonderful cat behind, so I retrieved Mullen from the ivy and put him carefully, with some resistance from him of course, into the strong box I’d built, put the box into the bed of the pickup and off toward Washington we went. I hated having him in the back but I thought he’d travel more comfortably that way.
A few minutes later I turned onto one of the many freeways around LA rolled down the passenger side window about a third of the way to get some air in as I buzzed along the highway at 70 miles an hour or so….Then I turned on some music and started dreaming about the house that I’d made the Decision to build on my new property…I’d never built a house before so the idea was a little scary, but I knew somehow if I learned some basic skills I would be able to build it. And I did. Anyway, I’d probably gone about 10 miles dreaming about this house, when suddenly like a bat out of hell, something came flying through the small opening in the passenger side window! What in the world was that!? I could hardly believe my eyes. It was Mullen! How in the heck did he do that? I quickly pulled over to the side of the Freeway and looked in the back to find a big whole torn out of that strong box. Somehow my wonderfully determined cat had gotten out of the box, climbed to the top of the covering I had built for the pickup and crawled along the waterproof fabric the entire length of the pickup. That was amazing enough at the fast speed the pickup was moving. But I was amazed that Mullen was able to then jump from the pickup cover, through that little opening in the window and sail safely as you please, into the passenger’s seat where he rode for the rest of the trip purring happily. And THAT’S HOW I KNOW THAT IF SOMETHING IS WANTED BADLY ENOUGH, IF IT’S IMPORTANT ENOUGH, YOU DO WHAT IT TAKES TO MAKE IT HAPPEN. by Mike Giulio Bianco January 8, 2009, Liège, Belgium, Centre Hospitalier Universitarie, According to reliable sources, Queen Fabiola of Belgium had a surgical procedure done, presumably to her thyroid, under hypno-sedation (HYP), instead of general anesthesia (GA).General anesthesia was contraindicated due to possible risks to the health of the over eighty year old patient. Her majesty was dismissed two days after the intervention without any complications The Centre Hospitalier Universitaire of Liège, Belgium, is one of the few famous medical centers adopting hypnosis as a complementary technique in anesthesia. The clinic has successfully applied hypnosis in over 5100 surgical interventions as an auxiliary technique, along with local anesthesia and light pharmacological sedation. Dr, Faymonville stated that not only is the hypnotic approach to surgery much more cost-effective but patients found the hypnotic experience special and pleasant. People are coming from all over the world to undergo this technique. After hypnosis was banned in 1845 by the American Medical Association, the use of hypnosis was reinstated in 1958. The technique began to be used by medical, dental and surgical practices more frequently, especially in Belgium. The successful use of hypnosis as a substitute for general anesthesia would encourage American medicine to also adopt this safe and efficient technique. Since 1992, in certain European countries, especially Belgium, hypnosis has been routinely used in more than 1000 procedures in plastic surgery. The clinical success and experience with this technique has led to further testing to see whether the hypnotic technique using active patient collaboration, may be used as an effective adjunct to intravenous pharmaceutical sedation ("hypno-sedation", (HS)) for endocrine surgery, as an alternative to general anesthesia. Between 1995 and 1998, nearly 2000 cervical endocrine surgical procedures, as well as 300 thyroidectomies and 3 dozen cervical explorations for hyperparathyroidism were performed under hypno-sedation. Conversion to general anesthesia was needed in only three cases (0.9%). All of the patients who had hypno-sedation, again reported a very pleasant experience and significantly less post-surgical pain. Chemical analgesic use was significantly reduced in these patients. Hospital stays were also significantly less, providing a substantial reduction of medical care expenses. Convalescence significantly improved and hospital stays were shortened after hypno-sedation so that the patients returned to their normal lives and social or professional activity more quickly. References: Functional neuroanatomy of the hypnotic state. Hypnosis with conscious sedation instead of general anesthesia? SECRET GARDEN INDUCTION This is an example of an induction can be used to promote safety and ego strengthening. Let me tell you about a secret garden that you may not even know that you know about. It is a very secret, private, and safe place surrounded by high walls that protect everything that grows inside. There is an entrance that is visible only to you…..because YOU HAVE the key that opens the door to this very special place…You can be curious about what this garden contains. All you need to do is reach for the key…open the door…and enter …into this beautiful and rich garden. The walls are high enough to keep you safe and secure within them….but not so high that the sun cannot shine onto every part of the garden. As you enter through the secret door, you can be curious……. and even have a feeling of anticipation…. for what you will find growing in your garden. As you step inside and look around…….you can notice just how calm and relaxed you feel, as you look at the rich yellows……the reds, and white……..the deep blues of the flowers that grow there. Notice…..as you walk along the garden path…….a sweet fragrance wafting through the air…How good it feels to take in a deep, relaxing breath of fresh air……..noticing how all the tensions and concerns of the day….simply float away as you exhale. And you can feel so relaxed and comfortable ……. safe and secure in this lovely and special place, can’t you? You can even sit down on a garden chair…….enjoying that feeling of letting go…….as you take in a deep breath….noticing just how comfortable and relaxed your whole body is feeling. You can see that the high walls keep you safe and protected, can’t you? This is your special garden……..where all kinds of plants can grow and flourish. Here and there…....you can become aware that some weeds have grown in……..There are leaves and branches that have fallen into the garden from the winter rains and storms. In your own time……and in your own way…….you can begin to clear the garden of the weeds, leaves and branches……….so that you can discover the rich and fertile soil underneath. Notice just how fertile and rich the soil is…… It is ready for you to plant the seeds of future flowers, shrubs, and trees. And there are so many different kinds of plants to choose from… so many possibilities, aren't there? Some seeds sprout very quickly and the flowers bloom in early spring…….others take longer to germinate…and flower later…….in the middle of the summer. They are beautiful in their own special way. There are also some plants that mature and flower even later ……..in the early fall……. These late blooming flowers are just as beautiful and worthwhile as the early bloomers……..with their the fall colors of yellow, orange, and red. Sometimes there are storms…and when the rains come down, the plants bend under the weight of the raindrops. Sometimes the wind blows the plants this way and that way…but the storms pass and the water that washes down on the plants brings nourishment to their roots. Every time the plants pass through a storm…they grow stronger and taller. This is a garden that is so safe and secure…a place where you can plant the seeds of anything you wish to have there. You can continue to grow those plants that you want to keep in your garden and discard any that you no longer need to hold on to. Submitted 4/5/04 by Judith Grosz, LCSW 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. 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: And .. Natalia … perhaps you can see a window of time… a wide open space...in your future mind … opening ... you… to the possibility… that… in a way known only to you can separate the urge…and the urgency… since they are not the same… there is all the space… time… distance… in the world between them… that's how far apart they are Therapeutic Outcome: The hypnosis took about 8 sessions. By the 4th 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 |
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